title: Surgical Resection for Hepatocellular Carcinoma with Concomitant Esophageal Varices.
abstract: BACKGROUND
  The management of hepatocellular carcinoma (HCC) in patients with concomitant esophageal varices (EV) remains controversial. We assessed the surgical outcome of hepatectomy and aimed to clarify the indications and management of HCC in patients with concomitant EV.
  
  
  METHODS
  We retrospectively enrolled 502 patients with HCC (100 with and 402 without EV), who underwent curative hepatectomy. We analyzed the prognostic outcomes and risk factors for EV bleeding after hepatectomy.
  
  
  RESULTS
  Overall survival (OS) was significantly lower in HCC patients with EV than in those without EV (p = 0.003), although recurrence-free survival was similar in both groups. Multivariate analysis showed that indocyanine green retention test at 15 min (ICGR15) >17 % (p = 0.007) and α-fetoprotein >12.5 ng/ml (p = 0.003) was independent predictors of poorer OS. Among patients with EV who underwent hepatectomy, multivariate analysis identified ICGR15 >17 % (p = 0.03) as the only independent predictor of poorer OS. There was no significant difference in OS between HCC patients with EV and ICGR15 ≤17.0 % and HCC patients without EV. Ten patients experienced EV bleeding after hepatectomy. Multivariate analysis showed that preoperative endoscopic findings of blue color EV (p = 0.008) and red color sign (p = 0.0005) were independent predictors of EV bleeding in patients with HCC after hepatectomy.
  
  
  CONCLUSIONS
  These results suggest that HCC patients with EV and ICGR15 ≤17 % may be suitable for surgery, but patients with preoperative endoscopic blue color EV and red color sign need to be managed appropriately.
authors.affiliation: Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, 730-8619, Japan, nharada@surg2.med.kyushu-u.ac.jp.
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Maeda
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kayashima
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Ishida
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000601:surgery*; D003116:Color; D018572:Disease-Free Survival; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007208:Indocyanine Green; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins; D007208:Indocyanine Green