ASO Author Reflections: Minimally Invasive Surgery for Hepatocellular Carcinoma in the Setting of Portal Vein Hypertension

Excerpt

Both the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) guidelines have endorsed the Barcelona Clinic Liver Cancer (BCLC) algorithm for the surgical treatment of patients with hepatocellular carcinoma (HCC).1 According to the EASL guidelines, ideal candidates for liver resection in the setting of cirrhosis include HCC patients with well-preserved liver function without portal vein hypertension (PVH; i.e. assessed by hepatic vein to portal system gradient [HVPSG] ≤ 10 mmHg or platelet count > 100,000/mL).2 Nevertheless, outcomes following hepatectomy for HCC in the setting of PVH have been increasingly reported to be acceptable.3 In addition, although the recommendations for surgical management of HCC patients have been validated in the setting of open liver resection, the role of minimally invasive surgery (MIS)4 among patients with PVH assessed by platelet count (< 100,000/mL) [PVH-PLT] remains largely unknown. In this study, we sought to characterize the outcomes of patients with PVH-PLT who underwent an open versus MIS liver resection of HCC using a large multi-institutional database.5 …