title: Prognostic impact of underlying liver fibrosis and cirrhosis after curative resection of hepatocellular carcinoma.
abstract: BACKGROUND
  In the case of hepatocellular carcinoma (HCC), underlying liver pathology may not only determine the feasibility of surgery but may also affect the postsurgical outcome. We report our experience after curative liver resection for HCC in patients with normal liver, liver fibrosis, and liver cirrhosis.
  
  
  METHODS
  A total of 72 patients after liver resection with curative intention were analyzed. Histopathologic findings of tumor-unaffected liver tissue were used for retrospective classification: group A (normal liver); group B (liver fibrosis); group C (liver cirrhosis). The groups were compared for differences in short-term surgical results, total survival, and recurrence-free survival.
  
  
  RESULTS
  The rate of major complications was 34.7% and did not significantly differ among groups. The overall perioperative mortality rate was 9.7%, with one patient dying in group A and three patients dying in each of the other two groups. Including perioperative mortality, the median overall survival for the whole group was 37.3 months (95% confidence interval 29.3-45.2 months). The respective 1-, 2-, and 5-year survival rates for group A (n = 21) were 86%, 71%, and 50% and for group C (n = 24) 62%, 50%, and 17%. The overall survival of group B (n = 27) was intermediate (log-rank, P = 0.032). The respective recurrence-free survival rates were 76%, 42%, and 20% for group A and 39%, 13%, and 4% for group C, with group B being intermediate (log-rank, P = 0.016).
  
  
  CONCLUSIONS
  Our data demonstrate that liver resection in the presence of compensated liver cirrhosis is feasible but associated with a significantly impaired prognosis for overall and recurrence-free survival. The management of cirrhotic patients with compensated liver function and HCC therefore also requires the opportunity for transplantation.
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Waldeyerstrasse 1, Muenster, 48149, Germany. Peter.Gassmann@ukmuenster.de
authors.forename: Peter
authors.initials: P
authors.lastname: Gassmann
authors.forename: Tilmann
authors.initials: T
authors.lastname: Spieker
authors.forename: Joerg
authors.initials: J
authors.lastname: Haier
authors.forename: Fabian
authors.initials: F
authors.lastname: Schmidt
authors.forename: Wolf Arif
authors.initials: WA
authors.lastname: Mardin
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult