title: Is liver resection for hepatocellular carcinoma in cirrhotic patients with high preoperative serum alanine aminotransferase level unadvisable?
abstract: OBJECTIVE
  High operative mortality has been reported after liver resection for hepatocellular carcinoma (HCC) in cirrhotic patients with high preoperative serum alanine aminotransferase (sALT) level. Their long-term prognosis has never been investigated. The aim of this study is to evaluate the benefit of liver resection for HCC in this subgroup of patients.
  
  
  METHODS
  A retrospective review of the medical records of 978 cirrhotic patients who underwent curative liver resection for HCC between 2000 and 2012 was conducted. The preoperative sALT level of 218 patients was > 100 U/l (normal 5 -50) (group 1). The clinicopathological characteristics as well as early and long-term results after hepatectomy of group 1 were compared with those of the other 760 cirrhotic patients whose sALT was < 100 U/l (group 2). Liver resection extent was decided by tumor extent and a modified version of Makuuchi’s criteria.
  
  
  RESULTS
  Group 1 patients had a significantly higher indocyanine 15-minute retention rate, higher hepatitis infection rates and a higher rate of macronodular cirrhosis. Although group 1 patients had a higher postoperative complication rate, the complication severity and 90-day mortality did not significantly differ. In 81.2 % of group 1 patients, sALT level returned to the normal range within 12 weeks after operation. The 5-year disease-free and overall survival rates in group 1 and 2 were 55.1% and 57.5% (P = 0.540) and 51.5% and 60.9%, (P=0.485), respectively.
  
  
  CONCLUSIONS
  Liver resection for HCC remains advisable in selected cirrhotic patients with preoperatively high sALT level when liver resection extent fulfills Makuuchi’s criteria for cirrhotic liver resection.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Lai
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Wu
authors.forename: John
authors.initials: J
authors.lastname: Wang
authors.forename: Cheng-Chan
authors.initials: CC
authors.lastname: Yu
authors.forename: Shao-Bin
authors.initials: SB
authors.lastname: Cheng
authors.forename: Dar-Cherng
authors.initials: DC
authors.lastname: Yeh
authors.forename: Fang-Ku
authors.initials: FK
authors.lastname: Peng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D000410:Alanine Transaminase