title: Hepatectomy for hepatocellular carcinoma in patients with hemophilia.
abstract: BACKGROUND
  Hepatitis C virus infection due to contamination in large-pool clotting factor concentrate is a major co-morbidity in adult patients with hemophilia. Although the development of hepatocellular carcinoma following infection with hepatitis virus is a crucial health problem, there are few reports of hemophilia patients undergoing liver resection for hepatocellular carcinoma.
  
  
  METHODS
  Six patients with hemophilia underwent liver resection for hepatocellular carcinoma in our department from January 2003 to December 2012. We compared these hemophilic patients (H group, n = 6) to control patients without hemophilia (C group, n = 191) who underwent liver resection in the same period.
  
  
  RESULTS
  All six patients in the H group were hepatitis C virus positive. Administration of coagulation factors was performed perioperatively, and no differences in the operative time and estimated blood loss were observed between the groups. No postoperative complications occurred in the H group, but five patients suffered from recurrence after surgery and subsequently underwent radiofrequency ablation or transcatheter arterial chemoembolization. The median recurrence-free survival time was 17.9 months and 25.3 months in H and C group, respectively, with no significant difference between the two groups.
  
  
  CONCLUSIONS
  Adequate replacement of coagulation factors enables hepatic resection for hepatocellular carcinoma patients with hemophilia.
authors.affiliation: Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. yinokawa@med.nagoya-u.ac.jp.
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Inokawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.forename: Shin
authors.initials: S
authors.lastname: Takeda
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Suzuki
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsushita
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hemophilia; Hepatocellular carcinoma; Resection