title: Morbidity of hepatic resection for intermediate and advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  According to current treatment guidelines, surgical resection of hepatocellular carcinoma (HCC) is mostly restricted to a limited subgroup of patients. Due to improved surgical techniques and perioperative management, liver resections may also be performed more extendedly and also in cirrhotic livers with clinical signs of portal hypertension in selected patients. In this study, the clinical and long-term outcomes of liver resection in HCC patients with or without liver cirrhosis were evaluated.
  
  
  METHODS
  One hundred fifty-eight patients undergoing liver resection for primary HCC at our institution were identified. Logistic and Cox regression analyses were used to identify prognostic parameters for postoperative complications and survival.
  
  
  RESULTS
  In our cohort of patients, there was no association between clinical parameters or extent of surgical resection and postoperative morbidity. Only Barcelona Clinic Liver Cancer (BCLC) stage C patients were at significantly higher risk for major complications (OR 5.27, P = 0.009). Risk factors influencing long-term survival were patient age (HR 1.026, P = 0.027) and BCLC stage C (HR 3.47, P = 0.002). Compared to patients without liver cirrhosis, BCLC stage A and B patients undergoing resection were at similar risk for the development of severe complications and long-term mortality.
  
  
  CONCLUSIONS
  Liver resection as potentially curative therapy can be performed in selected patients in BCLC stage B, as well as in patients with clinical signs of portal hypertension. The resection of HCC-classified BCLC stage C is feasible but associated with significant morbidity and mortality.
authors.affiliation: Department of Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany. philipp.renner@ukr.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Renner
authors.affiliation: Department of Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schuhbaum
authors.affiliation: Department of Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kroemer
authors.affiliation: Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Department of Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Loss
authors.affiliation: Department of Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
authors.forename: Sven A
authors.initials: SA
authors.lastname: Lang
authors.affiliation: Department of Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
authors.forename: Edward K
authors.initials: EK
authors.lastname: Geissler
authors.affiliation: Department of Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
authors.affiliation: Department of Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Farkas
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: BCLC; Hepatocellular carcinoma; Liver cancer; Liver resection; Portal hypertension