title: Hepatectomy for hepatocellular carcinoma patients with macronodular cirrhosis.
abstract: OBJECTIVE
  Patients with hepatocellular carcinoma (HCC) presenting with nonmicronodular or micronodular cirrhosis are usually treated by hepatectomy. The value of resection for patients with hepatitis B virus-related macronodular cirrhosis, however, remains unknown because of potentially fatal complications of this procedure.
  
  
  METHODS
  Clinicopathological data were analyzed for 85 resected HCC patients with hepatitis B virus-related macronodular cirrhosis. An additional 255 patients with nonmicronodular and micronodular cirrhosis were randomly selected during the same period as the control group.
  
  
  RESULTS
  Compared with nonmicronodular and micronodular cirrhosis patients, macronodular cirrhotic patients exhibited elevated alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase levels, higher Child-Pugh classification, higher indocyanine green retention rate at 15 min (ICG R15), and more number of total complications. No significant differences were observed between the two groups with regard to major complications, mortality, overall survival, and recurrence-free survival. The morbidity rate was relatively low in patients exhibiting low ICG R15 (<10%). Cox analysis identified small tumors (≤ 5 cm) and radical resection as independent prognostic factors that could predict long-term overall survival. Radical resection can result in high recurrence-free survival in macronodular cirrhotic patients.
  
  
  CONCLUSIONS
  Resection is safe for macronodular cirrhotic HCC patients, and radical resection provides a positive outcome. Small-sized patients are good candidates for hepatectomy. Macronodular cirrhosis should not rule out hepatectomy in patients with low ICG R15.
authors.affiliation: State Key Laboratory of Oncology in South China, Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Qing-an
authors.initials: QA
authors.lastname: Zeng
authors.forename: Jiliang
authors.initials: J
authors.lastname: Qiu
authors.forename: Jian
authors.initials: J
authors.lastname: Hong
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Shengping
authors.initials: S
authors.lastname: Li
authors.forename: Ruhai
authors.initials: R
authors.lastname: Zou
authors.forename: Pinzhu
authors.initials: P
authors.lastname: Huang
authors.forename: Binkui
authors.initials: B
authors.lastname: Li
authors.forename: Yun
authors.initials: Y
authors.lastname: Zheng
authors.forename: Xiangming
authors.initials: X
authors.lastname: Lao
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Yuan
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016022:Case-Control Studies; D000075202:Contraindications; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome