Liver resection of hepatocellular carcinoma in patients with portal hypertension and multiple tumors.

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. [ABSTRACT FROM AUTHOR]