title: Extended hepatic resection for hepatocellular carcinoma in patients with cirrhosis: is it justified?
abstract: OBJECTIVE
  To evaluate the perioperative outcomes and long-term survival of extended hepatic resection for hepatocellular carcinoma (HCC) in patients with cirrhosis.
  
  
  BACKGROUND
  Hepatic resection is a well-established treatment for HCC in cirrhotic patients with preserved liver function and limited disease. However, the role of extended hepatic resection (more than four segments) for HCC in cirrhotic patients has not been elucidated.
  
  
  METHODS
  Between 1993 and 2000, 45 consecutive patients with histologically confirmed cirrhosis underwent right or left extended hepatectomy for HCC (group A). Perioperative outcomes and long-term survival of these patients were compared with 161 patients with HCC and cirrhosis who underwent hepatic resection of a lesser extent in the same period (group B). All clinicopathologic and follow-up data were collected prospectively.
  
  
  RESULTS
  Group A patients had significantly higher intraoperative blood loss, longer operation time, and longer hospital stay than group B. However, the two groups were similar in overall morbidity and hospital mortality. There were no significant differences in the incidence of liver failure or other complications. The resection margin width was similar between the two groups. Despite significantly larger tumor size in group A compared with group B, long-term survival was comparable between the two groups.
  
  
  CONCLUSIONS
  Extended hepatic resection for HCC can be performed in selected cirrhotic patients with acceptable morbidity, mortality, and long-term survival that are comparable to those of lesser hepatic resection. Extended hepatectomy for large HCC extending from one lobe to the other or central HCC critically related to the hepatic veins is justifiable in cirrhotic patients with preserved liver function and adequate liver remnant.
authors.affiliation: Centre for the Study of Liver Disease & Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China. poontp@hkucc.hku.hk
authors.forename: Ronnie Tung Ping
authors.initials: RT
authors.lastname: Poon
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: Chi Leung
authors.initials: CL
authors.lastname: Liu
authors.forename: Chi Ming
authors.initials: CM
authors.lastname: Lam
authors.forename: Wai Kei
authors.initials: WK
authors.lastname: Yuen
authors.forename: Chun
authors.initials: C
authors.lastname: Yeung
authors.forename: John
authors.initials: J
authors.lastname: Wong
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate