Cassese, Gianluca (2023) Prognostic role of hepatic venous portal pressure gradients vs indocyanine green retention test and liver stiffness o n short term surgical outcomes for HCC o n liver cirrhosis : a multicenter prospective study. [Tesi di dottorato]
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| Tipologia del documento: | Tesi di dottorato |
|---|---|
| Lingua: | English |
| Titolo: | Prognostic role of hepatic venous portal pressure gradients vs indocyanine green retention test and liver stiffness o n short term surgical outcomes for HCC o n liver cirrhosis : a multicenter prospective study |
| Autori: | Autore Email Cassese, Gianluca gianluca.cassese@unina.it |
| Data: | 12 Dicembre 2023 |
| Numero di pagine: | 31 |
| Istituzione: | Università degli Studi di Napoli Federico II |
| Dipartimento: | Medicina Clinica e Chirurgia |
| Dottorato: | Terapie avanzate biomediche e chirurgiche |
| Ciclo di dottorato: | 36 |
| Coordinatore del Corso di dottorato: | nome email Pane, Fabrizio fabrizio.pane@unina.it |
| Tutor: | nome email De Palma, Giovanni Domenico [non definito] |
| Data: | 12 Dicembre 2023 |
| Numero di pagine: | 31 |
| Parole chiave: | Hepatocellular Carcinoma; Hepatic venous-portal gradient; Liver cirrhosis |
| Settori scientifico-disciplinari del MIUR: | Area 06 - Scienze mediche > MED/18 - Chirurgia generale |
| Depositato il: | 11 Gen 2024 09:38 |
| Ultima modifica: | 12 Mar 2026 10:40 |
| URI: | http://www.fedoa.unina.it/id/eprint/15641 |
Abstract
Introduction: Hepatic venous-portal gradient (HVPG) is the gold standard to role out the presence of portal hypertension (PHT) in cirrhotic patients. PHT is a contraindication to surgery in such patients. However, HVPG is not routinary performed because of its invasiveness, and many patients with PHT currently undergo liver resection, as reported in literature. Aim of this study is to prospectively compare the prognostic role of HVPG with commonly performed and validated non-invasive preoperative tests (indocyanine-green retention - ICG-R15- and liver stiffness -LSM-). Methods: The primary endpoint was the comparison of the predictive accuracy (evaluated as Area Under the Curve of the ROC curves) of HVPG, ICG-R15 and LSM on a Composite Endpoint defined as the development of Post-hepatectomy Lifev Failure, severe postoperative ascites, in hospital mortality, severe postoperative complications (defined as major than 3A according to Clavien Dindo classification). Results: The analysis of the ROC curves showed an AUC (area under the curve) of 0 514 for ICG R15 (p=0.61), 0 604 for LSM (p=0.66), 0.716 for HVPG (p=0.02). Conclusion: The predictive ability of HVPG on developing PHLF, in hospital mortality, large postoperative ascites and major postoperative complications in cirrhotic patients undergoing elective surgery for HCC was significantly higher than LSM and ICG R15 (p= 0.02).
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