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Additional Hassab's operation for esophagogastric varices in cirrhotic patients with resectable hepatocellular

Hiroyuki Sugo1, Noriko Fujiwara, Jiro Yoshimoto

  • 1Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. sugo@med.juntendo.ac.jp

Hepato-Gastroenterology
|December 24, 2008
PubMed

Insights

Adding Hassab's operation to hepatectomy in cirrhotic patients with hepatocellular carcinoma and esophagogastric varices may reduce fatal variceal hemorrhage risk without impacting overall prognosis.

Area of Science:

  • Hepatobiliary Surgery
  • Gastroenterology
  • Surgical Oncology

Background:

  • Hepatocellular carcinoma (HCC) in cirrhotic patients often co-exists with esophagogastric varices.
  • Hepatectomy is a standard treatment for resectable HCC.
  • The management of concomitant varices during hepatectomy presents a surgical challenge.

Purpose of the Study:

  • To evaluate the role of Hassab's operation as an adjunct to hepatectomy.
  • To assess its impact on outcomes in cirrhotic patients with HCC and esophagogastric varices.

Main Methods:

  • A comparative study of 36 cirrhotic patients with HCC and varices.
  • 20 patients underwent hepatectomy alone (non-Hassab group).
  • 16 patients underwent hepatectomy with Hassab's operation (Hassab group).

Main Results:

  • The Hassab group had more severe varices, lower platelets, poorer prothrombin time, and higher portal pressure preoperatively.
  • Despite these factors, operative mortality, postoperative course, and long-term prognosis showed no significant differences.
  • Crucially, fatal variceal hemorrhage occurred in 25% of the non-Hassab group versus 0% in the Hassab group (p<0.05).

Conclusions:

  • Hassab's operation may be a beneficial adjunct to hepatectomy in select patients.
  • It appears to reduce the risk of fatal variceal hemorrhage post-hepatectomy.
  • Further research may confirm its role in improving safety for HCC resection in cirrhotic patients with varices.
Abstract

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