title: Radiofrequency ablation plus devascularization is the preferred treatment of hepatocellular carcinoma with esophageal varices.
abstract: BACKGROUND
  Most hepatocellular carcinomas (HCCs) are associated with cirrhosis. Portal hypertension (PHT) and esophageal variceal bleeding (EVB) can limit the patient's treatment options. Surgical therapy in such patients is challenging. We performed devascularization plus liver resection or radiofrequency ablation (RFA) to treat HCC patients with concomitant EVB resulting from PHT secondary to cirrhosis. Such combined operations have never been reported for the management of HCC patients with variceal esophageal bleeding.
  
  
  OBJECTIVE
  To evaluate two different treatment regimens for patients with HCC and EVB.
  
  
  METHODS
  We evaluated 35 BCLC stage 0/A patients with HCC and EVB who underwent either devascularization plus liver resection (Group A) or devascularization plus RFA (Group B). We reviewed the safety and outcomes of the two groups and assessed risk factors for patient survival and tumor recurrence.
  
  
  RESULTS
  Significant factors for overall survival were surgical approach and Child-Pugh classification. Child-Pugh classification was the only independent risk factor for overall postoperative survival [hazard ratio (HR) 8.320, 95 % confidence interval (CI) 1.739-39.799, P = 0.008]. Age was the only independent risk factor for tumor recurrence (HR 4.025, 95 % CI 1.343-12.062, P = 0.013).
  
  
  CONCLUSIONS
  RFA plus devascularization is the preferred treatment of HCC with EVB. RFA plus devascularization should be considered in Child-Pugh class A patients below 50 years of age.
authors.affiliation: Department of Hepatobiliary Surgery, Beijing DiTan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Zhang
authors.forename: Li
authors.initials: L
authors.lastname: Jiang
authors.forename: Zhe
authors.initials: Z
authors.lastname: Jia
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhang
authors.forename: Rong
authors.initials: R
authors.lastname: He
authors.forename: Zhenhao
authors.initials: Z
authors.lastname: Ding
authors.forename: Yi
authors.initials: Y
authors.lastname: Mu
mesh_terms: D000328:Adult; D000367:Age Factors; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality