Brief Article
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World J Gastroenterol. Dec 14, 2011; 17(46): 5083-5088
Published online Dec 14, 2011. doi: 10.3748/wjg.v17.i46.5083
Hepatocellular carcinoma in cirrhotic patients with portal hypertension: Is liver resection always contraindicated?
Andrea Ruzzenente, Alessandro Valdegamberi, Tommaso Campagnaro, Simone Conci, Silvia Pachera, Calogero Iacono, Alfredo Guglielmi
Andrea Ruzzenente, Alessandro Valdegamberi, Tommaso Campagnaro, Simone Conci, Silvia Pachera, Calogero Iacono, Alfredo Guglielmi, Department of Surgery, Division of General Surgery “A”, GB Rossi Hospital, University of Verona, 37134 Verona, Italy
Author contributions: Guglielmi A, Iacono C and Ruzzenente A designed the research and supervised this work; Valdegamberi A and Campagnaro T wrote the paper; Conci S and Pachera S performed the research; Ruzzenente A analyzed the data.
Correspondence to: Andrea Ruzzenente, MD, Department of Surgery, Division of General Surgery “A”, GB Rossi Hospital, University of Verona, 37134 Verona, Italy. andrea.ruzzenente@fastwebnet.it
Telephone: +39-45-8124941 Fax: +39-45-585612
Received: January 25, 2011
Revised: May 26, 2011
Accepted: June 26, 2011
Published online: December 14, 2011
Abstract

AIM: To analyze the outcome of hepatocellular carcinoma (HCC) resection in cirrhosis patients, related to presence of portal hypertension (PH) and extent of hepatectomy.

METHODS: A retrospective analysis of 135 patients with HCC on a background of cirrhosis was submitted to curative liver resection.

RESULTS: PH was present in 44 (32.5%) patients. Overall mortality and morbidity were 2.2% and 33.7%, respectively. Median survival time in patients with or without PH was 31.6 and 65.1 mo, respectively (P = 0.047); in the subgroup with Child-Pugh class A cirrhosis, median survival was 65.1 mo and 60.5 mo, respectively (P = 0.257). Survival for patients submitted to limited liver resection was not significantly different in presence or absence of PH. Conversely, median survival for patients after resection of 2 or more segments with or without PH was 64.4 mo and 163.9 mo, respectively (P = 0.035).

CONCLUSION: PH is not an absolute contraindication to liver resection in Child-Pugh class A cirrhotic patients, but resection of 2 or more segments should not be recommended in patients with PH.

Keywords: Liver surgery; Hepatic resection; Hepatocellular carcinoma; Portal hypertension