Exploratory Evaluation of Hepatic Venous Pressure Gradient, Indocyanine Green Retention, and Liver Stiffness in Predicting Short-Term Outcomes After Liver Resection in Patients with Cirrhosis: A Multicenter Prospective Study

Introduction: The correct risk stratification is the key to achieving a low postoperative mortality after liver resection for HCC, including the evaluation of liver function and the presence of portal hypertension. The aim of this study was to evaluate the accuracy of Hepatic Venous-Portal pressure Gradients (HVPG), Indocyanine Green retention test (ICG-R15) and Liver Stiffness (LSM) in predicting the risk of post-hepatectomy liver failure and major postoperative complications in selected cirrhotic patients. Methods: A multicenter prospective study was designed, including consecutive cirrhotic patients undergoing liver resection for HCC. The predictive ability of HVPG, LSM and ICG-R15 was tested by evaluating the Area Under the ROC Curves. Results: Ninety-eight cirrhotic patients undergoing liver resection for HCC were included. Twelve patients (12.2%) developed at least one of the complications included within the composite endpoint. Three patients (3%) developed post-hepatectomy liver failure (PHLF) (one graded A and two graded C according to the International Study Group of Liver Surgery), five patients (5.1%) developed large ascites, five patients (5.1%) developed severe postoperative complications, two patients (2%) died during the hospital stay (PHLF). HVPG showed the higher AUC (0.778, 95% CI 0.641- 0.898; p < 0.001), followed by LSM (0.669, 95% CI 0.471–0.847; p = 0.097) and ICG-R15 (0.593, 95% CI 0.378–0.788; p = 0.615). Conclusions: In our cohort of selected HCC patients undergoing elective surgery, the predictive ability of HVPG on developing a composite endpoint including PHLF, in-hospital mortality, large postoperative ascites and major postoperative complications is higher than LSM and ICG-R15.