Ruan MH, Ye FY, Ma JN, Qian J, Zou MH, Zhou WX, Sheng J, Guo XG, Wei D, Zhang CJ, Liu H, Liu FC. Impact of clinically significant portal hypertension on posthepatectomy liver failure: A systematic review and meta-analysis. World J Hepatol 2026; 18(1): 111871 [DOI: 10.4254/wjh.v18.i1.111871]
Corresponding Author of This Article
Fu-Chen Liu, The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, No. 225 Changhai Road, Yangpu District, Shanghai 200438, China. liufuchenlfc@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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Systematic Reviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 27, 2026 (publication date) through Jan 27, 2026
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World Journal of Hepatology
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1948-5182
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Ruan MH, Ye FY, Ma JN, Qian J, Zou MH, Zhou WX, Sheng J, Guo XG, Wei D, Zhang CJ, Liu H, Liu FC. Impact of clinically significant portal hypertension on posthepatectomy liver failure: A systematic review and meta-analysis. World J Hepatol 2026; 18(1): 111871 [DOI: 10.4254/wjh.v18.i1.111871]
World J Hepatol. Jan 27, 2026; 18(1): 111871 Published online Jan 27, 2026. doi: 10.4254/wjh.v18.i1.111871
Impact of clinically significant portal hypertension on posthepatectomy liver failure: A systematic review and meta-analysis
Ming-Hao Ruan, Fei-Yang Ye, Jin-Ni Ma, Jin Qian, Ming-Hao Zou, Wen-Xuan Zhou, Jie Sheng, Xin-Gang Guo, Dong Wei, Cheng-Jing Zhang, Hui Liu, Fu-Chen Liu
Ming-Hao Ruan, Fei-Yang Ye, Jin Qian, Ming-Hao Zou, Wen-Xuan Zhou, Jie Sheng, Xin-Gang Guo, Dong Wei, Hui Liu, Fu-Chen Liu, The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China
Jin-Ni Ma, First School of Clinical Medicine, Anhui Medical University, Hefei 230032, Anhui Province, China
Cheng-Jing Zhang, Department of Nutrition, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China
Co-first authors: Ming-Hao Ruan and Fei-Yang Ye.
Co-corresponding authors: Hui Liu and Fu-Chen Liu.
Author contributions: Ruan MH and Ye FY made equal contributions as co-first authors; Ruan MH, Ye FY, Ma JN, Qian J, Zou MH, Zhou WX, Sheng J, Guo XG, and Wei D contributed to the acquisition, analysis, and interpretation of data for this article; Ruan MH drafted the manuscript; Liu FC contributed to the manuscript revision; Zhang CJ, Liu H, and Liu FC conceived and supervised the project; Liu H and Liu FC made equal contributions as co-corresponding authors; all authors approved the final version to publish.
Supported by National Natural Science Foundation of China. No. 82302906 and No. 82270634; and 2024 Research Plan Project of the Jiading District Natural Science Foundation, No. 2024-KY-JB-30.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Chen Liu, The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, No. 225 Changhai Road, Yangpu District, Shanghai 200438, China. liufuchenlfc@163.com
Received: July 14, 2025 Revised: August 21, 2025 Accepted: November 26, 2025 Published online: January 27, 2026 Processing time: 200 Days and 15.6 Hours
Abstract
BACKGROUND
The health challenges of partial hepatectomy in patients with clinically significant portal hypertension (CSPH) have been a subject of study for decades. No meta-analysis has systematically evaluated the relationship between CSPH and posthepatectomy liver failure (PHLF), despite its potential role as a critical factor in surgical decision-making. This systematic review and meta-analysis investigated the incidence of PHLF in patients with and without CSPH.
AIM
To include more recent studies and focus on short-term postoperative outcomes, particularly the association between CSPH and PHLF. Additionally, stratified analyses were also performed according to CSPH and PHLF assessment methods, study design, study period, surgical technique, and underlying liver diseases.
METHODS
A comprehensive literature search was conducted in EMBASE, PubMed, MEDLINE, ScienceDirect, Elsevier, and Cochrane databases using combinations of the following terms: (“portal hypertension” OR “hypertension, portal” OR “portal hypertensions”) AND (“hepatectomy” OR “hepatectomies” OR “liver resection”) AND (“liver failure” OR “hepatic failure” OR “liver decompensation”). Studies published from January 1996 to April 2025, 21 published studies were finally included in the systematic review and meta-analysis. The quality assessment was performed independently by using the Newcastle-Ottawa Scale. Odds ratios (OR) and 95% confidence intervals (CI) were calculated and compared using a random-effects model. Heterogeneity was assessed with the χ2 test, and the degree of inconsistency was measured using I2. A P value < 0.05 or I2 > 50% indicated substantial heterogeneity. Sensitivity analysis was conducted to test the robustness of the findings and to identify potential sources of bias.
RESULTS
A total of 6981 patients (1453 patients with CSPH and 5529 patients without CSPH) were finally included in this study. Compared with patients without CSPH, the incidences of PHLF increased in patients with CSPH (OR = 3.14; 95%CI: 2.45-4.02; P < 0.001). Subsequent subgroup analysis suggested that the diagnostic methods for CSPH is a potential interfering factor in PHLF, the OR was maximal in hepatic venous pressure gradient measurement groups (OR = 15.61; 95%CI: 2.11-115.35; P = 0.007).
CONCLUSION
The presence of CSPH should be considered as a significant risk factor, it still should be taken into account seriously prior to surgery and needs strict perioperative management. Meanwhile, different methods of diagnosing CSPH could influence PHLF.
Core Tip: The health challenges of partial hepatectomy in patients with clinically significant portal hypertension (CSPH) have been a subject of study for decades. There was no meta-analysis has systematically examined the relationship between CSPH and posthepatectomy liver failure (PHLF), despite its potential role as a critical factor in surgical decision-making. This systematic review and meta-analysis assessed PHLF in patients with and without CSPH and showed the presence of CSPH should be considered as a significant risk factor and should be taken into account seriously prior to surgery and needs strict perioperative management. Meanwhile, different methods of diagnosing CSPH could influence PHLF.
