title: Hepatic resection is safe and effective for patients with hepatocellular carcinoma and portal hypertension.
abstract: OBJECTIVE
  Official guidelines do not recommend hepatic resection (HR) for patients with hepatocellular carcinoma (HCC) and portal hypertension (PHT). This study aims to investigate the safety and efficacy of HR for patients with HCC and PHT.
  
  
  METHODS
  Mortality and survival after HR were analyzed retrospectively in a consecutive sample of 1738 HCC patients with PHT (n = 386) or without it (n = 1352). To assess the robustness of findings, we repeated the analysis using propensity score-matched analysis. We also comprehensively searched the PubMed database for studies evaluating the efficacy and safety of HR for patients with HCC and PHT.
  
  
  RESULTS
  The 90-day mortality rate was 6.7% among those with PHT and 2.1% among those without it (P<.001). Patients without PHT had a survival benefit over those with PHT at 1, 3, and 5 years (96% vs 90%, 75% vs 67%, 54% vs 45%, respectively; P = .001). In contrast, PHT was not associated with worse short- or long-term survival when only propensity score-matched pairs of patients and those with early-stage HCC or those who underwent minor hepatectomy were included in the analysis (all P>.05). Moreover, the recurrence rates were similar between the two groups. Consistent with our findings, all 9 studies identified in our literature search reported HR to be safe and effective for patients with HCC and PHT.
  
  
  CONCLUSIONS
  HR is safe and effective in HCC patients with PHT and preserved liver function. This is especially true for patients who have early-stage HCC or who undergo minor hepatectomy.
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Jian-Hong
authors.initials: JH
authors.lastname: Zhong
authors.affiliation: Ultrasound Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Hang
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of General Surgery Education, Guangxi Medical University, Nanning, PR China.
authors.forename: Nan
authors.initials: N
authors.lastname: Xiao
authors.affiliation: Hepatobiliary Surgery Department, the First Affiliated Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Xin-Ping
authors.initials: XP
authors.lastname: Ye
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Ke
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Wang
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Liang
authors.initials: L
authors.lastname: Ma
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Xue-Mei
authors.initials: XM
authors.lastname: You
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Zhi-Yuan
authors.initials: ZY
authors.lastname: Zhang
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Shi-Dong
authors.initials: SD
authors.lastname: Lu
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China.
authors.forename: Le-Qun
authors.initials: LQ
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000401:mortality* / Q000601:surgery; D008099:Liver / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000098:blood supply / Q000150:complications / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000098:blood supply / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome