title: Impact of severe oesophagogastric varices on liver resection for hepatocellular carcinoma in cirrhotic patients.
abstract: BACKGROUND
  The aim of the present study was to clarify both short-term and long-term results of patients with concomitant hepatocellular carcinoma (HCC) and high-risk oesophagogastric varices (OGV).
  
  
  METHODS
  This retrospective study identified 927 cirrhotic patients who underwent curative resection of HCC between 1995 and 2012 in single institution. Patients were separated into 3 groups (A, B, and C) according to general rules for recording endoscopic findings of oesophagogastric varices proposed in Japan in 1991. Groups A, B, and C consisted of patients without OGV (F0), patients with mild to moderate OGV (F1 to F2), and patients with high-risk OGV (F3 and/or red color sign), respectively. All patients in group C underwent prophylactic endoscopic variceal ligation/sclerotherapy. Post-operative complications, mortality, overall survival, and disease-free survival were compared among 3 groups.
  
  
  RESULTS
  No patient had post-operative variceal bleeding. Complication rates of Clavien-Dindo grade II to V in three groups were 13.6, 14.0, and 6.9 %, respectively (P > 0.05). Operative mortality, 5-year overall survival rate, and disease-free survival rate among the 3 groups were not significantly different (P > 0.05).
  
  
  CONCLUSIONS
  Prophylactic endoscopic variceal ligation/sclerotherapy effectively prevented from post-operative variceal bleeding in patients with high-risk OGV. Operative mortality, major morbidity, and survival of patients with high-risk OGV were similar to those of patients without OGV or those with mild OGV. Liver resection remains a feasible choice for cirrhotic patients with concomitant HCC and high-risk OGV.
authors.affiliation: Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, Roc.
authors.forename: Hsiao-Tien
authors.initials: HT
authors.lastname: Liu
authors.forename: Shao-Bin
authors.initials: SB
authors.lastname: Cheng
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Wu
authors.forename: Hong-Zen
authors.initials: HZ
authors.lastname: Yeh
authors.forename: Chi-Sen
authors.initials: CS
authors.lastname: Chang
authors.forename: John
authors.initials: J
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D018572:Disease-Free Survival; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011184:Postoperative Period; D012189:Retrospective Studies; D015911:Sclerotherapy; D012720:Severity of Illness Index; D015996:Survival Rate; D055815:Young Adult