Published date: Dec 26 2019

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 14 (2019), Issue No. 4

Pages: 225–251

DOI: 10.18502/sjms.v14i4.5902

Wael Mohialddin Ahmed Doushdr.wael.doush@gmail.comFaculty of Medicine and Health Sciences, Omdurman Islamic University, Department of Gastroenterological Surgery, Ibn Sina Specialized Hospital, Khartoum, Sudan

Juhaina Ahmed ElzeinDepartment of Family Medicine, Sudan Medical Specialization Board, Khartoum, Sudan

Background: Hepatocellular carcinoma (HCC) represents a fifth of common malignancies, with an annual diagnosis of 750,000 new cases. It is the third cause of cancer deaths worldwide. The cirrhotic liver is a leading cause of HCC with the annual conversion rate to HCC in the range of 2–6 %. The underlying liver cirrhosis limits certain treatment modalities that potentially further aggravates liver dysfunction. Over the past decade, there were substantial improvements in the HCC resection techniques that has resulted in the reduction of operative mortality. This allowed doing major hepatectomy in cirrhotic patients who are suitable for liver transplantation but lacking availability of cadaveric or living donors. Also, patients who have multi-focal HCC underlying cirrhosis which render them unsuitable for liver transplantation due to its extension beyond Milan criteria.

Objective: The objective of this study was to assess the benefits and selection criteria of HCC surgical resection within child–Turcotte–Pugh score (CTP) A and B liver cirrhosis to achieve the best surgical outcomes.

Methods: We performed a literature search within English written trials using PubMed and MEDLINE reviews databases from 1986 to 2017. One hundred fifty studies are included in this review evaluating various parameters including HCC and compensated cirrhosis prevalence, pathogenesis, clinical presentation, and diagnostic methods. Furthermore, we have compared oncological hepatic resection with other modalities like transarterial chemoembolization, liver transplantation, embolization of the portal vein, laparoscopic hepatic resection, and ALPPS technique. Principles of surgical hepatectomy and postoperative complications are also presented in this review.

Conclusion: This review has demonstrated that hepatic cirrhosis complicated by portal hypertension is not an absolute contraindication for HCC resection. Furthermore, elective surgery must not be directed exclusively to CTP A cirrhosis but it can be applied to highly selected patients who had suffered from advanced hepatic cirrhosis. If multifocal HCC underlying hepatic cirrhosis was unsuitable for liver transplantation, hepatectomy can be carried out to increase the tumor cure chances, prevent it's recurrences, and lead to significant survival rate improvement. The degree of cirrhosis significantly affects the decision of primary hepatic carcinoma treatment and it's prognosis. The interdisciplinary assessment of liver function by surgeons, hepatologists, anesthesiologists, and specialists of critical care are essential for maximum critical stabilization of the patients.  

Keywords: Child-Turcotte-Pugh score; hepatocellular carcinoma; hepatectomy; liver cirrhosis; portal hypertension

[1] Torre, L. A., Bray, F., Siegel, R. L., et al. (2015). Global cancer statistics 2012. CA: A Cancer Journal for Clinicians; vol. 65, pp. 87–108.

[2] Blachier, M., Leleu, H., Peck-Radosavljevic, M., et al. (2013). The burden of liver disease in Europe: a review of available epidemiological data. Journal of Hepatology, vol. 58, pp. 593–608.

[3] Zatonski, W. A., Sulkowska, U., Manczuk, M., et al. (2010). Liver cirrhosis mortality in Europe with special attention to Central and Eastern Europe. European Addiction Research, vol. 16, pp. 193–201.

[4] European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer. (2012). EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Journal of Hepatology, vol. 56, pp. 908– 943.

[5] Bridgewater, J., Galle, P. R., Khan, S. A., et al. (2014). Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. Journal of Hepatology, vol. 60, pp. 1268–1289.

[6] Molina, J. R., Yang, P., Cassivi, S. D., et al. (2008). Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship. Mayo Clinic Proceedings, vol. 83, pp. 584–594.

[7] Dam, M. K., Flensborg-Madsen, T., Eliasen, M., et al. (2013). Smoking and risk of liver cirrhosis: a population-based cohort study. Scandinavian Journal of Gastroenterology, vol. 48, pp. 585–591.

[8] Poschl, G. and Seitz, H. K. (2004). Alcohol and cancer. Alcohol and Alcoholism, vol. 39, pp. 155–165.

[9] Bugianesi, E. (2005). Steatosis, the metabolic syndrome and cancer. Alimentary Pharmacology & Therapeutics, vol. 22, pp. 40–43.

[10] Schuppan, D. and Afdhal, N. H. (2008). Liver cirrhosis. Lancet, vol. 371, pp. 838–851.

[11] Sorensen, H. T., Thulstrup, A. M., Mellemkjar, L., et al. (2003). Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark. Journal of Clinical Epidemiology, vol. 56, pp. 88–93.

[12] Jiao, J., Friedman, S. L., and Aloman, C. (2009). Hepatic fibrosis. Current Opinion in Gastroenterology, vol. 25, pp. 223–229.

[13] D’Amico, G., Garcia-Tsao, G., and Pagliaro, L. (2006). Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies. Journal of Hepatology, vol. 44, pp. 217–231.

[14] De Franchis, R. (2000). Updating consensus in portal hypertension: report of the baveno III consensus workshop on definitions, methodology and therapeutic strategies in portal hypertension. Journal of Hepatology, vol. 33, pp. 846–852.

[15] D’amico, G., Morabito, A., Pagliaro, L., et al. (1986). Survival and prognostic indicators in compensated and decompensated cirrhosis. Digestive Diseases and Sciences, vol. 31, pp. 468–475.

[16] El-Serag, H. B. (2011). Hepatocellular carcinoma. The New England Journal of Medicine, vol. 365, pp. 1118–1127.

[17] Bruno, S., Stroffolini, T., Colombo, M., et al. (2007). Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: A retrospective study. Hepatology, vol. 45, pp. 579–587.

[18] Liaw, Y. F., Tai, D. I., Chu, C. M., et al. (1986). Early detection of hepatocellular carcinoma in patients with chronic type B hepatitis: a prospective study. Gastroenterology, vol. 90, pp. 263–267.

[19] Cheng, E., Zarrinpar, A., Geller, D., et al. (2015). Liver. In: Brunicardi F (ed.) Principles of Surgery (tenth edition), p. 1291. New York, NY: McGraw Hill.

[20] Bosch, F. X., Ribes, J., Diaz, M., et al. (2004). Primary liver cancer: Worldwide incidence and trends. Gastroenterology, vol. 127, pp. S5–S16.

[21] But, D. Y., Lai, C. L., and Yuen, M. F. (2008). Natural history of hepatitis related hepatocellular carcinoma. World Journal of Gastroenterology, vol. 14, pp. 1652– 1656.

[22] Fattovich, G., Stroffolini, T., Zagni, I., et al. (2004). Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology, vol. 127, pp. S35–S50.

[23] Lok, A. S., Seeff, L. B., Morgan, T. R., et al. (2009). Incidence of hepatocellular carcinoma and associated risk factors in hepatitis C-related advanced liver disease. Gastroenterology, vol. 136, pp. 138–148.

[24] O’shea, R. S., Dasarathy, S., and McCullough, A. J. (2010). Alcoholic liver disease. Hepatology, vol. 51, pp. 307–328.

[25] Velazquez, R. F., Rodriguez, M., Navascues, C. A., et al. (2003). Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis. Hepatology, vol. 37, pp. 520–527.

[26] Calle, E. E., Rodriguez, C., Walker-Thurmond, K., et al. (2003). Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. The New England Journal of Medicine, vol. 348, pp. 1625–1638.

[27] Veldt, B. J., Chen, W., Heathcote, E. J., et al. (2008). Increased risk of hepatocellular carcinoma among patients with hepatitis C cirrhosis and diabetes mellitus. Hepatology, vol. 47, pp. 1856–1862.

[28] Bruix, J. and Sherman, M. (2011). Management of hepatocellular carcinoma: An update. Hepatology, vol. 53, pp. 1020–1022.

[29] Erez, A., Shchelochkov, O. A., Plon, S. E., et al. (2011). Insights into the pathogenesis and treatment of cancer from inborn errors of metabolism. American Journal of Human Genetics, vol. 88, pp. 402–421.

[30] Walker, M., El-Serag, H. B., Sada, Y., et al. (2016). Cirrhosis is under-recognised in patients subsequently diagnosed with hepatocellular cancer. Alimentary Pharmacology & Therapeutics, vol. 43, pp. 621–630.

[31] Muir, A. J. (2015). Understanding the complexities of cirrhosis. Clinical Therapeutics, vol. 37, pp. 1822–1836.

[32] Garcia-Tsao, G., Sanyal, A. J., Grace, N. D., et al. (2007). Prevention and management of gas-troesophageal varices and variceal hemorrhage in cirrhosis. Hepatology, vol. 46, pp. 922–938.

[33] Grattagliano, I., Ubaldi, E., Portincasa, P., et al. (2009). Liver disease: Early signs you may be missing. Journal of Family Practice, vol. 58, pp. 514–521.

[34] Valla DC. (2003). The diagnosis and management of the budd-chiari syndrome: consensus and controversies. Hepatology, vol. 38, pp. 793–803.

[35] Ripoll, C., Croszmann, R., Gracia-Tesoa, G., et al. (2007). Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology, vol. 133, pp. 481–488.

[36] Stefaniuk, P., Cianciara, J., and Wiercinska-Drapalo, A. (2010). Present and future possibilities for early diagnosis of hepatocellular carcinoma. World Journal of Gastroenterology, vol. 16, pp. 418–424.

[37] Simonovsky, V. (1999). The diagnosis of cirrhosis by high resolution ultrasound of the liver surface. British Journal of Radiology, vol. 72, pp. 29–34.

[38] Berzigotti, A., Abraldes, J., Tandon, P., et al. (2010). Ultrasonographic evaluation of liver surface and transient elastography in clinically doubtful cirrhosis. Journal of Hepatology, vol. 52, pp. 846–853.

[39] EASL-ALEH. (2015). Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. Journal of Hepatology, vol. 63, pp. 237–264.

[40] Castera, L. (2012). Non-invasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology, vol. 142, pp. 1293–1302.

[41] Brancatelli, G., Federle, M., Ambrosini, R., et al. (2007). Cirrhosis: CT and MR imaging evaluation. European Journal of Radiology, vol. 61, pp. 57–69.

[42] Smith, A., Branch, C., Zand, K., et al. (2016). Liver surface nodularity quantication from routine ct images as a biomarker for detection and evaluation of cirrhosis. Radiology, vol. 280, pp. 771–781.

[43] Ghanaati, H., Alavian, S. M., Jafarian, A., et al. (2012). Imaging and imaging guided interventions in the diagnosis and management of hepatocellular carcinoma (HCC)- review of evidence. Iranian Journal of Radiology, vol. 9, pp. 167–177.

[44] Bruix, J. and Sherman, M. (2011). Management of hepatocellular carcinoma: An update. Hepatology, vol. 53, pp. 1020–1022.

[45] Blum, H. (2011). Hepatocellular carcinoma: HCC. Hepatitis Monthly, vol. 11, pp. 69–70.

[46] Bialecki, E., Ezenekwe, A., Brunt, E., et al. (2006). Comparison of liver biopsy and non-invasive methods for diagnosis of hepatocellular carcinoma. Clinical Gastroenterology and Hepatology, vol. 4, pp. 361–368.

[47] Zhang, B. H., Yang, B. H., and Tang, Z. Y. (2004). Randomized controlled trial of screening for hepatocellular carcinoma. Journal of Cancer Research and Clinical Oncology, vol. 130, pp. 417–422.

[48] Hennedige, T. and Venkatesh, S. (2013). Imaging of hepatocellular carcinoma: diagnosis, staging and treatment monitoring. Cancer Imaging, vol. 12, pp. 530–547.

[49] El-Serag, H., Marrero, J., Rudolph, L., et al. (2008). Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology, vol. 134, pp. 1752–1763.

[50] EASL. (2012). Management of alcoholic liver disease. Journal of Hepatology, vol. 57, pp. 399–420.

[51] Ho, C., Chen, S., Yeung, D., et al. (2007). Dual-tracer PET/CT imaging in evaluation of metastatic hepatocellular carcinoma. Journal of Nuclear Medicine, vol. 48, pp. 902–909.

[52] Russell, M. C. (2015). Complications following hepatectomy. Surgical Oncology Clinics of North America, vol. 24, pp. 73–96.

[53] Durand, F. and Valla, D. (2008). Assessment of prognosis of cirrhosis. Seminars in Liver Disease, vol. 28, pp. 110–122.

[54] Gozzetti, G., Mazziotti, A., Cavallari, A., et al. (1988). Clinical experience with hepatic resections for hepatocellular carcinoma in patients with cirrhosis. Surgery, Gynecology & Obstetrics, vol. 166, pp. 503–510.

[55] Matsumata, T., Kanematsu, T., Shirabe, K., et al. (1990). Decreased morbidity and mortality rates in surgical patients with hepatocellular carcinoma. British Journal of Surgery, vol. 77, pp. 677–680.

[56] Tjandra, J. J., Fan, S. T., and Wong, J. (1991). Peri-operative mortality in hepatic resection. ANZ Journal of Surgery, vol. 61, pp. 201–206.

[57] Fan, S. T., Lai, E. C., Lo, C. M., et al. (1995). Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Archives of Surgery, vol. 130, pp. 198–203.

[58] Capussotti, L., Borgonovo, G., Bouzari, H., et al. (1994). Results of major hepatectomy for large primary liver cancer in patients with cirrhosis. British Journal of Surgery, vol. 81, pp. 427–431.

[59] Belghiti, J. and Kianmanesh, R. (2005). Surgical treatment of hepatocellular carcinoma. HPB, vol. 7, pp. 42–49.

[60] Eguchi, S., Kanematsu, T., Arii, S., et al. (2011). Recurrence-free survival more than 10 years after liver resection for hepatocellular carcinoma. British Journal of Surgery, vol. 98, pp. 552–557.

[61] Landman, M. P., Feurer, I. D., Pinson, C. W., et al. (2011). Which is more cost effective under the MELD system: Primary liver transplantation, or salvage transplantation after hepatic resection or after locoregional therapy for hepatocellular carcinoma within Milan criteria? HPB, vol. 13, pp. 783–791.

[62] Sala, M., Fuster, J., Llovet, J. M., et al. (2004). High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation. Liver Transplantation, vol. 10, pp. 1294–1300.

[63] Cucchetti, A., Vitale, A., Gaudio, M. D., et al. (2010). Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma. American Journal of Transplantation, vol. 10, pp. 619–627.

[64] Kishi, Y., Hasegawa, K., Sugawara, Y., et al. (2011). Hepatocellular carcinoma: current management and future development-improved outcomes with surgical resection. International Journal of Hepatology, vol. 2011, pp. 1–10.

[65] Torzilli, G., Belghiti, J., Kokudo, N., et al. (2013). A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: Is it adherent to the EASL/AASLD recommendations? An observational study of the HCC east-west study group. Annals of Surgery, vol. 257, pp. 929–937.

[66] Verloh, N., Haimerl, M., Zeman, F., et al. (2014). Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla. European Radiology, vol. 24, pp. 1013–1019.

[67] Cucchetti, A., Ercolani, G., Vivarelli, M., et al. (2009). Is portal hypertension a contraindication to hepatic resection? Annals of Surgery, vol. 250, pp. 922–928.

[68] Dahl, E., Rumessen, J., and Gluud, L. L. (2011). Systematic review with metaanalyses of studies on the association between cirrhosis and liver metastases. Hepatology Research, vol. 41, pp. 618–625.

[69] Cai, B., Liao, K., Song, X. Q., et al. (2014). Patients with chronically diseased livers have lower incidence of colorectal liver metastases: A meta-analysis. Plos One, vol. 9, e108618.

[70] Berzigotti, A., Reig, M., Abraldes, J. G., et al. (2015). Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and metaanalysis. Hepatology, vol. 61, pp. 526–536.

[71] Ishizawa, T., Hasegawa, K., Aoki, T., et al. (2008). Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology, vol. 134, pp. 1908–1916.

[72] Zhong, J. H., Ke, Y., Gong, W. F., et al. (2014). Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma. Annals of Surgery, vol. 260, pp. 329–340.

[73] Chang, W. T., Kao, W. Y., Chau, G. Y., et al. (2012). Hepatic resection can provide longterm survival of patients with non-early-stage hepatocellular carcinoma: Extending the indication for resection? Surgery, vol. 152, pp. 809–820.

[74] Liu, P. H., Hsia, C. Y., Lee, Y. H., et al. (2015). Surgical resection versus transarterial chemoembolization for BCLC stage C hepatocellular carcinoma. Journal of Surgical Oncology, vol. 111, pp. 404–409.

[75] Vitale, A., Burra, P., Frigo, A. C., et al. (2015). Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona clinic liver cancer stages: A multicentre study. Journal of Hepatology, vol. 62, pp. 617–624.

[76] Yin, L., Li, H., Li, A. J., et al. (2014). Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan Criteria: A RCT. Journal of Hepatology, vol. 61, pp. 82–88.

[77] Chua, T., Liauw, W., Saxena, A., et al. (2010). Systematic review of neoadjuvant transarterial chemoembolization for resectable hepatocellular carcinoma. Liver International, vol. 30, pp. 166–174.

[78] Young, A. L., Malik, H. Z., Abu-Hilal, M., et al. (2007). Large hepatocellular carcinoma: time to stop preoperative biopsy. Journal of the American College of Surgeons, vol. 205, pp. 453–462.

[79] Ikai, I., Yamamoto, Y., Yamamoto, N., et al. (2003). Results of hepatic resection for hepatocellular carcinoma invading major portal and/or hepatic veins. Surgical Oncology Clinics, vol. 12, pp. 65–75.

[80] Wang, B. W., Mok, K. T., Liu, S. I., et al. (2008). Is hepatectomy beneficial in the treatment of multinodular hepatocellular carcinoma? Journal of the Formosan Medical Association, vol. 107, pp. 616–626.

[81] Ng, K. K., Vauthey, J. N., Pawlik, T. M., et al. (2005). Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Annals of Surgical Oncology, vol. 12, pp. 364–373.

[82] Guglielmi, A., Ruzzenente, A., Conci, S., et al. (2012). How much remnant is enough in liver resection? Digestive Surgery, vol. 29, pp. 6–17.

[83] Shirabe, K., Shimada, M., Gion, T., et al. (1999). Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. Journal of the American College of Surgeons, vol. 188, pp. 304–309.

[84] Schindl, M. J., Redhead, D. N., Fearon, K. C., et al. (2005). The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut, vol. 54, pp. 289–296.

[85] Popescu, G. A., Alexandrescu, S. T., Grigorie, R. T., et al. (2017). Good to know: The ALPPS procedure - Embracing a new technique. Chirurgia, vol. 112, pp. 332–341.

[86] Farges, O., Malassagne, B., Flejou, J. F., et al. (1999). Risk of major liver resection in patients with underlying chronic liver disease. Annals of Surgery, vol. 229, pp. 210–215.

[87] Cucchetti, A., Ercolani, G., Vivarelli, M., et al. (2006). Impact of model for endstage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transplantation, vol. 12, pp. 966–971.

[88] McCormack, L., Petrowsky, H., Jochum, W., et al. (2007). Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: A matched casecontrol study. Annals of Surgery, vol. 245, pp. 923–930.

[89] The, S. H., Christein, J., Donohue, J., et al. (2005). Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: Model of End-Stage Liver Disease (MELD) score predicts perioperative mortality. Journal of Gastrointestinal Surgery, vol. 9, pp. 1207– 1215.

[90] Hsu, K. Y., Chau, G. Y., Lui, W. Y., et al. (2009). Predicting morbidity and mortality after hepatic resection in patients with hepatocellular carcinoma: The role of model for end-stage liver disease score. World Journal of Surgery, vol. 33, pp. 2412–2419.

[91] Forner, A., Reig, M. E., de Lope, C. R., et al. (2010). Current strategy for staging and treatment: The BCLC update and future prospects. Seminars in Liver Disease, vol. 30, pp. 61–74.

[92] Llovet, J. M., Bru, C., and Bruix, J. (1999). Prognosis of hepatocellular carcinoma: The BCLC staging classification. Seminars in Liver Disease, vol. 19, pp. 329–338.

[93] Durand, F. and Valla, D. (2008). Assessment of prognosis of cirrhosis. Seminars in Liver Disease, vol. 28, pp. 110–122.

[94] Malinchoc, M., Kamath, P. S., Gordon, F. D., et al. (2000). A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, vol. 31, pp. 864–871.

[95] Delis, S. G., Bakoyiannis, A., Dervenis, C., et al. (2009). Perioperative risk assessment for hepatocellular carcinoma by using the MELD score. Journal of Gastrointestinal Surgery, vol. 13, pp. 2268–2275.

[96] Cescon, M., Cucchetti, A., Grazi, G. L., et al. (2009). Indication of the extent of hepatectomy for hepatocellular carcinoma on cirrhosis by a simple algorithm based on preoperative variables. Archives of Surgery, vol. 144, pp. 57–63.

[97] Yamazaki, S. and Takayama, T. (2008). Surgical treatment of hepatocellular carcinoma: evidence-based outcomes. World Journal of Gastroenterology, vol. 14, pp. 685–692.

[98] Fan, S. T. (2010). Liver functional reserve estimation: state of the art and relevance for local treatments: The eastern perspective. Journal of Hepato-biliary-pancreatic Sciences, vol. 17, pp. 380–384.

[99] Zipprich, A., Kuss, O., Rogowski, S., et al. (2010). Incorporating indocyanin green clearance into the model for end stage liver disease (MELD-ICG) improves prognostic accuracy in intermediate to advanced cirrhosis. Gut, vol. 59, pp. 963–968.

[100] Lau, H., Man, K., Fan, S. T., et al. (1997). Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. British Journal of Surgery, vol. 84, pp. 1255–1259.

[101] Kudo, M., Izumi, N., Kokudo, N., et al. (2011). Management of hepatocellular carcinoma in Japan: Consensus-based clinical practice guidelines proposed by the Japan society of hepatology ( JSH) 2010 updated version. Digestive Diseases, vol. 29, pp. 339–364.

[102] Earl, T. M. and Chapman, W. C. (2011). Conventional surgical treatment of hepatocellular carcinoma. Clinics in Liver Disease, vol. 15, pp. 353–370.

[103] Capussotti, L., Ferrero, A., Vigano, L., et al. (2006). Portal hypertension: Contraindication to liver surgery? World Journal of Surgery, vol. 30, pp. 992–999.

[104] Kawano, Y., Sasaki, A., Kai, S., et al. (2008). Short- and long-term outcomes after hepatic resection for hepatocellular carcinoma with concomitant esophageal varices in patients with cirrhosis. Annals of Surgical Oncology, vol. 15, pp. 1670–1676.

[105] Sugimachi, K., Ikeda, Y., Tomikawa, M., et al. (2008). Appraisal of hepatic resection in the treatment of hepatocellular carcinoma with severe thrombocytopenia. World Journal of Surgery, vol. 32, pp. 1077–1081.

[106] Matsumata, T., Taketomi, A., Kawahara, N., et al. (1994). Morbidity and mortality after hepatic resection in the modern era. Hepato-gastroenterology, vol. 42, pp. 456–460.

[107] Poon, R. T., Fan, S. T., and Wong, J. (2002). Does diabetes mellitus influence the perioperative outcome or long term prognosis after resection of hepatocellular carcinoma? American Journal of Gastroenterology, vol. 97, pp. 1480–1488.

[108] Forner, A., Llovet, J. M., and Bruix, J. (2012). Hepatocellular carcinoma. Lancet, vol. 379, pp. 1245–1255.

[109] Llovet, J. M., Fuster, J., and Bruix, J. (1999). Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology, vol. 30, pp. 1434–1440.

[110] Zhang, Y. Q. and Guo, J. S. (2015). Antiviral therapies for hepatitis B virus related hepatocellular carcinoma. World Journal of Gastroenterology, vol. 21, pp. 3860– 3866.

[111] Sugawara, Y., Yamamoto, J., Higashi, H., et al. (2002). Preoperative Portal embolization in patients with hepatocellular carcinoma. World Journal of Surgery, vol. 26, pp. 105–110.

[112] Farges, O., Belghiti, J., Kianmanesh, R., et al. (2003). Portal vein embolization before right hepatectomy: Prospective clinical trial. Annals of Surgery, vol. 237, pp. 208–217.

[113] Abulkhir, A., Limongelli, P., Healey, A. J., et al. (2008). Preoperative portal vein embolization for major liver resection: A meta-analysis. Annals of Surgery, vol. 247, pp. 49–57.

[114] Hwang, S., Lee, S. G., Ko, G. Y., et al. (2009). Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Annals of Surgery, vol. 249, pp. 608–616.

[115] Yoo, H., Kim, J. H., Ko, G. Y., et al. (2011). Sequential transcatheter arterial chemoembolization and portal vein embolization versus portal vein embolization only before major hepatectomy for patients with hepatocellular carcinoma. Annals of Surgical Oncology, vol. 18, pp. 1251–1257.

[116] Jones, R., Moulton, C., and Hardy, K. (1998). Central venous pressure and its effect on blood loss during liver resection. British Journal of Surgery, vol. 85, pp. 1058–1060.

[117] Huntington, J., Royall, N., and Schmidt, C. (2014). Minimizing blood loss during hepatectomy: A literature review. Journal of Surgical Oncology, vol. 109, pp. 81– 88.

[118] Belghiti, J., Noun, R., Zante, E., et al. (1996). Portal triad clamping or hepatic vascular exclusion for major liver resection: A controlled study. Annals of Surgery, vol. 224, pp. 155–161.

[119] Brooks, A., Hammond, J., Girling, K., et al. (2007). The effect of hepatic vascular inflow occlusion on liver tissue pH, carbon dioxide, and oxygen partial pressures: defining the optimal clamp/release regime for intermittent portal clamping. Journal of Surgical Research, vol. 141, pp. 247–251.

[120] Capussotti, L., Nuzzo, G., Polastri, R., et al. (2003). Continuous versus intermittent portal triad clamping during hepatectomy in cirrhosis. Results of a prospective, randomized clinical trial. Hepato-gastroenterology, vol. 50, pp. 1073–1077.

[121] Lesurtel, M., Lehmann, K., De Rougemont, O., et al. (2009). Clamping techniques and protecting strategies in liver surgery. HPB, vol. 11, pp. 290–295.

[122] Dahiya, D., Wu, T. J., Lee, C. F., et al. (2010). Minor versus major hepatic resection for small hepatocellular carcinoma (HCC) in cirrhotic patients: A 20-year experience. Surgery, vol. 147, pp. 676–685.

[123] Duan, Y. F., Li, X. D., Sun, D. L., et al. (2015). A preliminary study on surgery for hepatocellular carcinoma patients with portal hypertension. American Journal of Surgery, vol. 210, pp. 129–133.

[124] Shi, M., Guo, R. P., Lin, X. J., et al. (2007). Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: A prospective randomized trial. Annals of Surgery, vol. 245, pp. 36–43.

[125] Poon, R. T., Fan, S. T., Ng, I. O., et al. (2000). Significance of resection margin in hepatectomy for hepatocellular carcinoma: A critical reappraisal. Annals of Surgery, vol. 231, pp. 544–551.

[126] Rau, H. G., Duessel, A. P., and Wurzbacher, S. (2008). The use of water-jet dissection in open and laparoscopic liver resection. HPB, vol. 10, pp. 275–280.

[127] Rau, H. G., Wichmann, M. W., Schinkel, S., et al. (2001). Surgical techniques in hepatic resections: Ultrasonic aspirator versus jet-cutter: A prospective randomized clinical trial. Zentralbl Chir, vol. 126, pp. 586–590.

[128] Cannon, R. M., Saggi, B., and Buell, J. F. (2014). Evaluation of a laparoscopic liver resection in the setting of cirrhosis. HPB, vol. 16, pp. 164–169.

[129] Hoffmann, K., Mueller-Buetow, V., Franz, C., et al. (2014). Factors predictive of survival after stapler hepatectomy of hepatocellular carcinoma: A multivariate, single-center analysis. Anticancer Research, vol. 34, pp. 767–776.

[130] Liu, C. L., Fan, S. T., Cheung, S. T., et al. (2006). Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: A prospective randomized controlled study. Annals of Surgery, vol. 244, pp. 194–203.

[131] Lai, E. C., Fan, S. T., Lo, C. M., et al. (1996). Anterior approach for difficult major right hepatectomy. World Journal of Surgery, vol. 20, pp. 314–317.

[132] Wu, T. J., Wang, F., Lin, Y. S., et al. (2010). Right hepatectomy by the anterior method with liver hanging versus conventional approach for large hepatocellular carcinomas. British Journal of Surgery, vol. 97, pp. 1070–1078.

[133] Belghiti, J. (2010). Editorial perspective: Resection of large hepatocellular carcinoma using combination of liver hanging maneuver and anterior approach. World Journal of Surgery, vol. 34, pp. 1879–1880.

[134] Hoots, W. K., Buchanan, G. R., Parmley, R. T., et al. (1991). Comprehensive care for patients with hemophilia: An expanded role in reducing risk for human immunodeficiency virus. Texas Medicine, vol. 87, pp. 73–75.

[135] Jarnagin, W., Chapman, W. C., Curley, S., et al. (2010). Surgical treatment of hepatocellular carcinoma: Expert consensus statement. HPB, vol. 12, pp. 302–310.

[136] Chung, C. D., Lau, L. L., Ko, K. L., et al. (2010). Laparoscopic liver resection for hepatocellular carcinoma. Asian Journal of Surgery, vol. 33, pp. 168–172.

[137] Nguyen, K. T., Gamblin, T. C., and Geller, D. A. (2009). World review of laparoscopic liver resection—2,804 patients. Annals of Surgery, vol. 250, pp. 831–841.

[138] Rao, A., Rao, G., and Ahmed, I. (2012). Laparoscopic or open liver resection? Let systematic review decide it. American Journal of Surgery, vol. 204, pp. 222–231.

[139] Buell, J. F., Cherqui, D., Geller, D. A., et al. (2009). The international position on laparoscopic liver surgery: The Louisville statement, 2008. Annals of Surgery, vol. 250, pp. 825–830.

[140] Laurent, A., Tayar, C., Andreoletti, M., et al. (2009). Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma. Journal of Hepato-biliary-pancreatic Sciences, vol. 16, pp. 310–314.

[141] Ramos, F. M., Loinaz, S. C., Fernandez, C. J., et al. (2011). Laparoscopic and hand-assisted liver resection: Preliminary results at a mid-sized hospital. Hepatogastroenterology, vol. 58, pp. 492–496.

[142] Cho, J. Y., Han, H. S., Yoon, Y. S., et al. (2008). Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver with a special reference to overcoming current limitations on tumor location. Surgery, vol. 144, pp. 32–38.

[143] Capussotti, L., Muratore, A., Amisano, M., et al. (2005). Liver resection for hepatocellular carcinoma on cirrhosis: Analysis of mortality, morbidity and survival— A European single centre experience. European Journal of Surgical Oncology, vol. 31, pp. 986–993.

[144] Balzan, S., Belghiti, J., Farges, O., et al. (2005). The “50-50 criteria” on postoperative day 5: An accurate predictor of liver failure and death after hepatectomy. Annals of Surgery, vol. 242, pp. 824–829.

[145] Rahbari, N. N., Garden, O. J., Padbury, R., et al. (2011). Posthepatectomy liver failure: A definition and grading by the international study group of liver surgery (ISGLS). Surgery, vol. 149, pp. 713–724.

[146] Pessaux, P., Msika, S., Atalla, D., et al. (2003). Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicentre study of 4718 patients. Archives of Surgery, vol. 138, pp. 314–324.

[147] Gomez-Jimenez, J., Ribera, E., Gasser, I., et al. (1993). Randomized trial comparing ceftriaxone with cefonicid for treatment of spontaneous bacterial peritonitis in cirrhotic patients. Antimicrobial Agents and Chemotherapy, vol. 37, pp. 1587–1592.

[148] Rimola, A., Navasa, M., and Arroyo, V. (1995). Experience with cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis. Diagnostic Microbiology and Infectious Disease, vol. 22, pp. 141–145.

[149] Peck, K. R., Cheong, H. S., Kang, C. I., et al. (2009). Clinical significance and outcome of nosocomial acquisition of spontaneous bacterial peritonitis in patients with liver cirrhosis. Clinical Infectious Diseases, vol. 48, pp. 1230–1236.

[150] De Goede, B., Klitsie, P. J., Hagen, S. M., et al. (2013). Meta-analysis of laparoscopic versus open cholecystectomy for patients with liver cirrhosis and symptomatic cholecystolithiasis. British Journal of Surgery, vol. 100, pp. 209–216.