Hepatocellular carcinoma in cirrhotic patients with portal hypertension:Is liver resection always contraindicated?

AIM:To analyze the outcome of hepatocellular car-cinoma(HCC)resection in cirrhosis patients,related to presence of portal hypertension(PH)and extent of hepatectomy.METHODS:A retrospective analysis of 135 patients with HCC on a background of cirrhosis was submitted to curative liver resection.RESULTS:PH was present in 44(32.5%)patients.Overall mortality and morbidity were 2.2% and 33.7%,respectively.Median survival time in patients with or without PH was 31.6 and 65.1 mo,respectively(P=0.047);in the subgroup with Child-Pugh class A cirrhosis,median survival was 65.1 mo and 60.5 mo,respectively(P=0.257).Survival for patients submitted to limited liver resection was not significantly different in presence or absence of PH.Conversely,median survival for patients after resection of 2 or more segments with or without PH was 64.4 mo and 163.9 mo,respectively(P=0.035).CONCLUSION:PH is not an absolute contraindication to liver resection in Child-Pugh class A cirrhotic patients,but resection of 2 or more segments should not be recommended in patients with PH.