Surgical Interventions for Hepatocellular Carcinoma with Portal Hypertension

Hepatocellular carcinoma (HCC) arising in the context of portal hypertension presents a complex therapeutic dilemma, balancing oncological clearance against the risk of decompensated liver function. Portal hypertension often coexists with cirrhosis-associated hypersplenism and variceal formation, raising the stakes of bleeding and postoperative hepatic failure. In recent years, multidisciplinary strategies have focused on refining surgical indications, optimising preoperative assessment of liver reserve and portal pressure, and integrating ancillary procedures such as splenectomy or endoscopic variceal ligation to mitigate haemodynamic stress. Innovations in minimally invasive approaches, including laparoscopic-guided radiofrequency ablation and hand-assisted techniques, have further reduced perioperative morbidity. Advances in patient stratification—particularly with Child–Pugh grading and assessment of hypersplenism severity—have informed tailored resections, while combined procedures have shown promise in extending recurrence-free intervals without compromising overall survival. The global burden of HCC and variability in resource settings have driven a spectrum of interventions, underscoring the need for standardised protocols that can be adapted to local expertise and patient comorbidities.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Surgical Interventions for Hepatocellular Carcinoma with Portal Hypertension publication trend

The graph below shows the total number of articles in surgical interventions for hepatocellular carcinoma with portal hypertension across all publications each year (not limited to Nature Index journals).

Technical terms

Hepatectomy: Surgical resection of part or all of the liver to remove tumour tissue.

Splenectomy: Surgical removal of the spleen, often performed to alleviate hypersplenism and reduce portal flow.

Portal Hypertension: Elevated blood pressure within the portal venous system, commonly due to cirrhosis.

Hypersplenism: Overactivity of the spleen causing cytopenias and exacerbating portal hypertension.

Child–Pugh Score: Clinical grading system for liver disease severity, using bilirubin, albumin, INR, ascites and encephalopathy.

Radiofrequency Ablation: Minimally invasive technique using thermal energy to destroy tumour cells in situ.

References

1. Benefits of Splenectomy and Curative Treatments for Patients with Hepatocellular Carcinoma and Portal Hypertension: a Retrospective Study. Journal of Gastrointestinal Surgery (2018).
2. Effects of hypersplenism on the outcome of hepatectomy in hepatocellular carcinoma with hepatitis B virus related portal hypertension. Frontiers in Surgery (2023).