Performance of Liver and Spleen Stiffness Measurements in Predicting Postoperative Hepatic Decompensation After HCC Resection

  • Horia StefanescuEmail author
  • Oana Nicoara-Farcau
  • Andreea Ardelean
  • Bogdan Procopet


Portal hypertension (PH) is a major determinant of the outcome of patients with hepatocellular carcinoma (HCC) undergoing curative treatment, especially resection. Liver and spleen stiffness (LS and SS) are both validated noninvasive surrogates for PH estimation. This review summarizes the evidences regarding the use of liver and spleen stiffness as predictors of post-hepatectomy liver failure, late recurrence, and overall survival in patients with liver cirrhosis and HCC undergoing surgical resection, or other therapies (i.e., radiofrequency or microwave ablation or transarterial chemoembolization) and highlights the utility of integrating these simple investigations into clinical daily practice. Taken together, LS measurement is validated as a valuable clinical tool in decision-making in patients with cirrhosis and resectable HCC. It can predict the occurrence of post-hepatectomy liver failure as well as late (>2 years) recurrence and overall survival. If used together with the MELD score—as an accurate estimation of liver function, it can help to navigate between oncological benefit and risk of decompensation and death. Considering 10% as an acceptable postoperative risk of decompensation, only patients with LSM <10 kPa should undergo resection. Moreover, an increased baseline LS (>13 kPa) appears to be the sole independent non-cancer-related predictor of late recurrence after radiofrequency ablation therapy. SS measurement appears to be a valuable additional noninvasive predictor of post-hepatectomy liver failure (PHLF) and late recurrence, with doubtful benefit in predicting overall survival. In patients who undergo local therapies, early changes in tumor stiffness may predict response. However, prospective randomized controlled trials are still needed to elucidate controversial findings.


Liver stiffness Spleen stiffness Hepatocellular carcinoma Prediction Post-hepatectomy liver failure Recurrence Survival 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Horia Stefanescu
    • 1
    • 2
    Email author
  • Oana Nicoara-Farcau
    • 2
    • 3
  • Andreea Ardelean
    • 2
    • 3
  • Bogdan Procopet
    • 1
    • 2
    • 3
  1. 1.Liver UnitRegional Institute of Gastroenterology and HepatologyCluj-NapocaRomania
  2. 2.Liver Research ClubCluj-NapocaRomania
  3. 3.3rd Medical Clinic, Department of Internal MedicineCluj-Napoca University of Medicine and PharmacyCluj-NapocaRomania

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