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Liver resection of hepatocellular carcinoma in patients with portal hypertension and multiple tumors
Author(s) -
Ohkubo Takao,
Midorikawa Yutaka,
Nakayama Hisashi,
Moriguchi Masamichi,
Aramaki Osamu,
Yamazaki Shintaro,
Higaki Tokio,
Takayama Tadatoshi
Publication year - 2018
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13047
Subject(s) - medicine , hepatocellular carcinoma , portal hypertension , gastroenterology , hazard ratio , confidence interval , liver cancer , proportional hazards model , carcinoma , multivariate analysis , cirrhosis , surgery
Aim Liver resection for hepatocellular carcinoma (HCC) has been recommended only for patients with a single tumor without portal hypertension. We aimed to validate this treatment strategy that is based on by the Barcelona Clinic Liver Cancer staging system. Methods Patients undergoing liver resection were divided into two groups: patients with single HCC without portal hypertension (Group 1) and those with at least one factors of portal hypertension and multiple tumors, up to three lesions each ≤3 cm (Group 2). We compared survival and postoperative complications between the two groups. Results The median overall and recurrence‐free survival periods of patients in Group 1 ( n = 695) were 8.5 years (95% confidence interval [CI], 6.6–9.0) and 2.4 years (2.2–2.7), respectively, and were significantly longer compared with those of patients in Group 2 ( n = 197) (5.6 years [95% CI, 4.8–6.7], P = 0.001, and 1.9 years [1.6–2.1], P < 0.001). On multivariate analysis, the independent factors for overall survival were hepatitis C virus infection (hazard ratio, 1.29 [95% CI, 1.02–1.65], P = 0.032), multiple tumors (1.42 [1.01–1.98], P = 0.040), and vascular invasion (1.66 [1.31–2.10], P < 0.001). Frequency of morbidity (23 [3.3%] patients vs 11 [5.5%] patients, P = 0.143) and mortality (3 [0.4%] patients vs 2 [1.0%] patients, P = 0.305) was not significantly different between the two groups. Conclusions Patients with HCC with portal hypertension and/or multiple tumors could be candidates for liver resection due to the safety of the procedure.