title: Morphologic severity of cirrhosis determines the extent of liver resection in patients with hepatocellular carcinoma and Child-Pugh grade A cirrhosis.
abstract: BACKGROUND
  Liver resection is the mainstay of treatment for patients with hepatocellular carcinoma and compensated cirrhosis. We investigated the relationship between the morphologic severity of cirrhosis and post-hepatectomy liver failure (PHLF) and evaluated the role of cirrhosis staging in determination of the extent limit for liver resection.
  
  
  METHODS
  The clinicopathologic data of 672 consecutive patients with Child-Pugh grade A liver function who underwent curative liver resection for hepatocellular carcinoma in Tongji Hospital from 2009 to 2013 were retrospectively reviewed. Severity of cirrhosis was staged morphologically and histologically. Risk factors for histologic cirrhosis and PHLF were analyzed. The extent limit of liver resection with reference to morphologic staging was studied.
  
  
  RESULTS
  Morphologic and histologic stages were significantly correlated (τ = 0.809, P < 0.001). Multivariate analysis showed that morphologic staging was the most crucial factor for histologic cirrhosis (odds ratio = 26.99, 95% confidence interval = 16.88-43.14, P < 0.001) and PHLF (odds ratio = 11.48, 95% confidence interval = 6.04-21.82, P < 0.001). The incidence of PHLF was high in patients with mild cirrhosis after resection of four or more liver segments (13.6%), those with moderate cirrhosis after major resection (38.1%), and those with severe cirrhosis or severe portal hypertension after resection of two or more liver segments (63.2% and 50.0%, respectively).
  
  
  CONCLUSIONS
  Morphologic severity of cirrhosis is an independent predictor of PHLF. Resection of fewer than four liver segments is justified in patients with mild cirrhosis. Major resection is not recommended in patients with moderate cirrhosis. In patients with severe cirrhosis or severe portal hypertension, only resection of fewer than two liver segments can be safely performed.
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Qingdao, China; Department of Surgery, Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Shao-jun
authors.initials: SJ
authors.lastname: Zhou
authors.affiliation: Department of Surgery, Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Er-lei
authors.initials: EL
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Bin-yong
authors.initials: BY
authors.lastname: Liang
authors.affiliation: Department of Surgery, Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Zun-yi
authors.initials: ZY
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Ke-shuai
authors.initials: KS
authors.lastname: Dong
authors.affiliation: Department of General Surgery, The First Hospital of Nanchang, Nanchang, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Hou
authors.affiliation: Department of Surgery, Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Xiao-ping
authors.initials: XP
authors.lastname: Chen
authors.affiliation: Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: karren126@126.com.
authors.forename: Min
authors.initials: M
authors.lastname: Xiong
authors.affiliation: Department of Surgery, Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: zyhuang2015@hotmail.com.
authors.forename: Zhi-yong
authors.initials: ZY
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D017093:Liver Failure / Q000209:etiology*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Hepatectomy; Hepatocellular carcinoma; Liver cirrhosis; Post-hepatectomy liver failure