title: Hepatocellular carcinoma in cirrhotic patients with portal hypertension: is liver resection always contraindicated?
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Division of General Surgery "A", GB Rossi Hospital, University of Verona, 37134 Verona, Italy. andrea.ruzzenente@fastwebnet.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruzzenente
authors.forename: Alessandro
authors.initials: A
authors.lastname: Valdegamberi
authors.forename: Tommaso
authors.initials: T
authors.lastname: Campagnaro
authors.forename: Simone
authors.initials: S
authors.lastname: Conci
authors.forename: Silvia
authors.initials: S
authors.lastname: Pachera
authors.forename: Calogero
authors.initials: C
authors.lastname: Iacono
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guglielmi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology* / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome