Impact of clinically significant portal hypertension on posthepatectomy liver failure: A systematic review and meta-analysis

Table 1 Main characteristics of studies included in this systematic review

Ref.	Included population	Proportion of Child A (%)	Study design	Geographical area	Period of inclusion	Assessment of CSPH1	Definition of liver failure2
[31]	1461	NR	Retrospective	Asia (China)	November 2009-November 2014	NR	ISGLS
[33]	1025	90.6	Retrospective	Asia (Japan)	October 2002-July 2014	Standard surrogate criteria	ISGLS
[21]	217	82.0	Retrospective	Europe (Italy)	January 1985-December 2003	Standard surrogate criteria	NR
[24]	100	100.0	Retrospective	Asia (Korea)	January 1996-August 2006	Standard surrogate criteria	NR
[32]	185	95.1	Retrospective	Asia (China)	April 2015-June 2016	Standard surrogate criteria	ISGLS
[26]	209	97.6	Retrospective	Asia (China)	January 2003-December 2008	Standard surrogate criteria	ISGLS
[25]	177	94.6	Retrospective	Asia (Japan)	January 1997-December 2009	PVP	Other 1
[28]	152	92.1	Retrospective	Asia (Korea)	January 2001-December 2010	Standard surrogate criteria	ISGLS
[23]	241	94.6	Retrospective	Europe (Italy)	January 1997-March 2007	Standard surrogate criteria	ISGLS
[29]	672	100.0	Retrospective	Asia (China)	January 2009-December 2013	Standard surrogate criteria	50-50 criteria
[12]	355	93.8	Retrospective	Asia (China)	2010-2014	Standard surrogate criteria	ISGLS
[27]	125	96.8	Retrospective	Asia (China)	May 2001-December 2008	Standard surrogate criteria	50-50 criteria
[34]	352	91.2	Retrospective	Asia (China)	September 2005-December 2015	Standard surrogate criteria	50-50 criteria
[30]	892	82.3	Retrospective	Asia (Japan)	2001-2015	Standard surrogate criteria	NR
[7]	29	100.0	Prospective	Europe (Spain)	May 1991-June 1994	HVPG	Other 2
[22]	40	77.5	Retrospective	Asia (Taiwan)	January 1995-June 2003	NR	Other 3
[15]	96	98.0	Retrospective	Europe (France, Spain)	April 1, 2011-March 31, 2018	Standard surrogate criteria	NR
[13]	170	NR	Retrospective	Africa (Egypt)	January 2011-July 2015	Standard surrogate criteria	NR
[18]	223	100.0	Prospective	Europe (France, Italy)	February 1997-May 2012	Standard surrogate criteria	ISGLS
[19]	70	100.0	Prospective	Europe (Italy)	October 2009-November 2014	HVPG	ISGLS
[20]	190	100.0	Prospective	Asia (China)	April 2009-May 2011	PVP	ISGLS

¹Hepatic venous pressure gradient ≥ 10 mmHg; portal venous pressure ≥ 20 cmH₂O; standard surrogate criteria: Presence of gastroesophageal varices or platelet count < 100000/mL and spleen diameter > 12 cm.

²International Study Group of Liver Surgery: An increased international normalized ratio of prothrombin time and concomitant hyperbilirubinemia on or after postoperative day 5; 50-50 criteria: Prothrombin time less than 50% and serum total bilirubin > 50 μmol/L on postoperative day 5; other 1: Liver failure was defined by hyperbilirubinaemia, severe ascites, lower prothrombin time and raised sustained levels in liver function tests after hepatectomy; other 2: Liver failure was defined by the presence of at least one sign of hepatic decompensation (jaundice, ascites, or encephalopathy) 3 months after surgery; other 3: Posthepatectomy hepatic failure was defined as when a patient died of unresolved hepatic decompensation within 3 months, without tumour recurrence.

NR: Not reported; PVP: Portal venous pressure; HVPG: Hepatic venous pressure gradient; ISGLS: International Study Group of Liver Surgery.

Table 2 Characteristics of surgical intervention, operative, and perioperative outcomes in the included studies

Ref.	Number	PHLF, %		Hospital stay, day		Type of resection (> 2 segments, %)
		CSPH	Without CSPH	CSPH	Without CSPH	CSPH	Without CSPH
[31]	1461	40.00	15.10	NR	NR	NR	NR
[33]	1025	8.70	2.40	NR	NR	NR	NR
[21]	217	14.10	7.60	NR	NR	16.70	33.90
[24]	100	8.50	1.90	NR	NR	NR	NR
[32]	185	35.30	10.10	NR	NR	NR	NR
[26]	209	37.30	17.80	12.9 ± 3.9	12.1 ± 5.3	NR	NR
[25]	177	14.60	1.60	NR	NR	NR	NR
[28]	152	43.20	35.20	NR	NR	NR	NR
[23]	241	11.20	3.90	NR	NR	2.20	6.60
[29]	672	19.00	7.50	NR	NR	NR	NR
[12]	355	14.80	4.10	14 (10-19)	11 (9-14)	9.80	22.40
[27]	125	15.50	9.00	NR	NR	NR	NR
[34]	352	7.50	4.90	NR	NR	NR	NR
[30]	892	0.50	0.40	13 (7-190)	12 (4-93)	4.60	14.20
[7]	29	73.30	0.00	NR	NR	NR	NR
[22]	40	62.50	9.40	NR	NR	NR	NR
[15]	96	9.40	0.00	6 (4-8)	4 (3-5)	3.20	6.20
[13]	170	28.60	15.20	12 ± 10	9 ± 5	40.70	38.00
[18]	223	28.60	13.80	NR	NR	17.50	31.30
[19]	70	50.00	11.10	9 (5-23)	8 (5-55)	20.60	50.00
[20]	190	59.00	24.00	NR	NR	52.50	29.50

NR: Not reported; PHLF: Posthepatectomy liver failure; CSPH: Clinically significant portal hypertension.