Letter to the Editor: Use of Direct Liver Stiffness Measurement in Evaluating the Severity of Liver Cirrhosis in Patient
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LETTER TO THE EDITOR
Letter to the Editor: Use of Direct Liver Stiffness Measurement in Evaluating the Severity of Liver Cirrhosis in Patients with Hepatocellular Carcinoma Antonio Pesce1 • Carlo Vittorio Feo2,3
Accepted: 15 September 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Dear Editor, We read with great interest the article by Gu et al. [1] in which the authors have investigated the effective role of direct liver stiffness measurement in evaluating the severity of liver cirrhosis in patients with HCC undergone surgical resection. We would like to raise some interesting points. In their study, the authors found the direct liver stiffness measurement more effective to preoperative transient elastography in assessing the severity of hepatic cirrhosis in HCC patient, especially in moderate-to-severe cirrhosis with a sensitivity of 95.3% and 83.3%, respectively. Regarding etiology, they only analyzed liver cirrhosis due to hepatitis B and C; they do not show data about other etiologies, such as alcoholic or nonalcoholic steatohepatitis (NASH). Nowadays, the prevalence of these etiologies in Western countries is increasing rapidly. We wonder whether the novel device could have the same sensitivity in assessing the severity of liver cirrhosis in these clinical settings. In the discussion section of the manuscript the authors stated that, to date, transient elastography has not been used for evaluating the severity of liver cirrhosis in HCC patients scheduled for hepatectomy. Actually, in a previous study on 77 HCC patients [2] the preoperative liver
stiffness measurement was used to provide a better evaluation of portal hypertension and to predict surgical risk in resectable single HCC. Moreover, Kim et al. [3] reported liver stiffness measurement of 25.6 kPa and a IGC R15 of 12% as the most accurate cutoff values for the prediction of postoperative hepatic failure. An important point of weakness of this study is represented by the impossibility to perform a direct liver stiffness measurement in patients undergoing liver resection by laparoscopic or robotic approach. As evidenced from the literature, mini-invasive approaches in hepatic surgery are associated with a significant decrease in the incidence of postoperative ascites and liver failure [4]. This concept lies on the preservation of collateral circulation in the abdomen, reducing the damage to muscles and round ligament, which may contain important collateral vessels. Furthermore, the authors considered this new device very useful for a quick evaluation of the severity of liver cirrhosis, but we think that the extents of hepatectomy should be accurately evaluated before surgery and not intra-operatively, especially in HCC patients according to Barcelona Clinic Liver Cancer staging system [5].
Funding None. Compliance with ethical standards & Antonio Pesce [email protected]
Conflict of interest All authors declare that they have no conflict of interest.
1
Unit of General Surgery, Ospedale del Delta, Azienda USL Di Ferrara, Ferrara, Italy
2
U
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