title: Is there any benefit from expanding the criteria for the resection of hepatocellular carcinoma in cirrhotic liver? Experience from a developing country.
abstract: BACKGROUND
  Patients with large-size (>10 cm) hepatocellular carcinoma (HCC) in Child B cirrhosis are usually excluded from curative treatment, i.e., hepatic resection, because of marginal liver function and poor outcome. This study was designed to evaluate the feasibility of the radiofrequency (RF)-assisted sequential "coagulate-cut liver resection technique" in expanding the criteria for resection of large HCC in cirrhotic livers with impaired liver function.
  
  
  METHODS
  Forty patients with Child-Pugh A or B cirrhosis underwent liver resection from December 1, 2001 to December 31, 2008. Of these, 20 patients (13 Child-Pugh A and 7 Child-Pugh B) with advanced stage HCC (stage B and C according to Barcelona-Clinic Liver Cancer Group) underwent major liver resection. The two groups were comparable in terms of patient age, liver cirrhosis etiology, tumor number, and size.
  
  
  RESULTS
  All resections were performed without the Pringle maneuver. There was no significant difference found between the two groups regarding resection time, perioperative transfusion, postoperative complications, hospital stay, and day 7 values of hemoglobin and liver enzymes. Likewise, there was no significant difference found in the overall survival between Child A and Child B patients who underwent major liver resection
  
  
  CONCLUSIONS
  RF-assisted sequentional "coagulate-cut liver resection technique" may be a viable alternative for management of patients with advanced HCC in cirrhotic liver with impaired function.
authors.affiliation: First Surgical Clinic, Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia. galun@eunet.rs
authors.forename: Danijel A
authors.initials: DA
authors.lastname: Galun
authors.forename: Predrag
authors.initials: P
authors.lastname: Bulajic
authors.forename: Marinko
authors.initials: M
authors.lastname: Zuvela
authors.forename: Dragan
authors.initials: D
authors.lastname: Basaric
authors.forename: Tatjana
authors.initials: T
authors.lastname: Ille
authors.forename: Miroslav N
authors.initials: MN
authors.lastname: Milicevic
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D003906:Developing Countries; D005260:Female; D006489:Hemostatic Techniques; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011846:Radio Waves; D055771:Serbia