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Surgical Outcomes for Hepatocellular Carcinoma in Patients with Child–Pugh Class B: a Retrospective Multicenter Study

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Backgrounds

Liver resection for hepatocellular carcinoma (HCC) in patients with Child–Pugh class (CPC) B increases the incidence of postoperative complication and in-hospital death and decreases the disease-free survival (DFS) and overall survival (OS) compared with those with CPC A. Conversely, some selected patients possibly gained benefits for liver resection.

Methods

Clinical records of 114 patients with CPC B who underwent liver resection for HCC were retrospectively reviewed. The risk of postoperative complications (Clavien–Dindo classification grade of ≥ II), postoperative recurrence, and death was analyzed.

Results

Postoperative complications occurred in 36 patients (31.6%), and 2 died within 90 days postoperatively due to the liver and respiratory failure, respectively. Multivariate analysis indicated that albumin-bilirubin (ALB) grade III and extended operation time were found as independent risk factors for postoperative complications. The DFS and OS rates at 3/5 years after liver resection were 30.8%/25.3% and 68.4%/48.9%, respectively. Multivariate analysis indicated that the extended blood loss, high α-fetoprotein (AFP) level (≥ 200 ng/mL), and Barcelona Clinic Liver Cancer stage C were found to be independent risk factors for postoperative recurrence. The high AFP level was also an independent prognostic factor for OS. Patients with high AFP levels had postoperative recurrence within 2 years and a higher number of extrahepatic recurrences than those with low AFP levels (< 200 ng/mL).

Conclusion

For patients with HCC with CPC B who were scheduled for liver resection, ALBI grade III and high AFP level should be considered as unfavorable outcomes after liver resection.

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136: E359-86.

    Article  CAS  PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68: 7-30.

    Article  PubMed  Google Scholar 

  3. Kokudo N, Takemura N, Hasegawa K, Takayama T, Kubo S, Shimada M, Nagano H, Hatano E, Izumi N, Kaneko S, Kudo M, Iijima H, Genda T, Tateishi R, Torimura T, Igaki H, Kobayashi S, Sakurai H, Murakami T, Watadani T, Matsuyama Y. Clinical practice guidelines for hepatocellular carcinoma: The Japan Society of Hepatology 2017 (4th JSH-HCC guidelines) 2019 update. Hepatol Res 2019;49: 1109-13.

    Article  PubMed  Google Scholar 

  4. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018;69: 182–236.

  5. Kubo S, Tsukamoto T, Hirohashi K, Tanaka H, Shuto T, Takemura S, Yamamoto T, Uenishi T, Ogawa M, Kinoshita H. Correlation between preoperative serum concentration of type IV collagen 7s domain and hepatic failure following resection of hepatocellular carcinoma. Ann Surg 2004;239: 186-93.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kusano T, Sasaki A, Kai S, Endo Y, Iwaki K, Shibata K, Ohta M, Kitano S. Predictors and prognostic significance of operative complications in patients with hepatocellular carcinoma who underwent hepatic resection. Eur J Surg Oncol 2009;35: 1179-85.

    Article  CAS  PubMed  Google Scholar 

  7. Giuliante F, Ardito F, Pinna AD, Sarno G, Giulini SM, Ercolani G, Portolani N, Torzilli G, Donadon M, Aldrighetti L, Pulitano C, Guglielmi A, Ruzzenente A, Capussotti L, Ferrero A, Calise F, Scuderi V, Federico B, Nuzzo G. Liver resection for hepatocellular carcinoma </=3 cm: results of an Italian multicenter study on 588 patients. J Am Coll Surg 2012;215: 244-54.

    Article  PubMed  Google Scholar 

  8. Kabir T, Syn NL, Tan ZZX, Tan HJ, Yen C, Koh YX, Kam JH, Teo JY, Lee SY, Cheow PC, Chow PKH, Chung AYF, Ooi LL, Chan CY, Goh BKP. Predictors of post-operative complications after surgical resection of hepatocellular carcinoma and their prognostic effects on outcome and survival: A propensity-score matched and structural equation modelling study. Eur J Surg Oncol 2020;46: 1756-65.

    Article  PubMed  Google Scholar 

  9. Koh YX, Tan HJ, Liew YX, Syn N, Teo JY, Lee SY, Goh BKP, Goh GBB, Chan CY. Liver Resection for Nonalcoholic Fatty Liver Disease-Associated Hepatocellular Carcinoma. J Am Coll Surg 2019;229: 467-78 e1.

    Google Scholar 

  10. Chen YS, Hsieh PM, Lin HY, Hung CM, Lo GH, Hsu YC, Lu IC, Lee CY, Wu TC, Yeh JH, Hsiao P, Li YC, Wang YC, Hsieh KC, Lin CW. Surgical resection significantly promotes the overall survival of patients with hepatocellular carcinoma: a propensity score matching analysis. BMC Gastroenterol 2021;21: 220.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Berardi G, Morise Z, Sposito C, Igarashi K, Panetta V, Simonelli I, Kim S, Goh BKP, Kubo S, Tanaka S, Takeda Y, Ettorre GM, Wilson GC, Cimino M, Chan CY, Torzilli G, Cheung TT, Kaneko H, Mazzaferro V, Geller DA, Han HS, Kanazawa A, Wakabayashi G, Troisi RI. Development of a nomogram to predict outcome after liver resection for hepatocellular carcinoma in Child-Pugh B cirrhosis. J Hepatol 2020;72: 75-84.

    Article  PubMed  Google Scholar 

  12. Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, Kawasaki S. Surgery for small liver cancers. Semin Surg Oncol 1993;9: 298-304.

    Article  CAS  PubMed  Google Scholar 

  13. Tanaka S, Takemura S, Shinkawa H, Nishioka T, Hamano G, Kinoshita M, Ito T, Kubo S. Outcomes of pure laparoscopic versus open hepatic resection for hepatocellular carcinoma in cirrhotic patients: A case-control study with propensity score matching. Eur Surg Res 2015;55: 291-301.

    Article  PubMed  Google Scholar 

  14. Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau WY, Makuuchi M, Strong RW. The Brisbane 2000 terminology of liver anatomy and resection. HPB 2000;2: 333-9.

    Article  Google Scholar 

  15. Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, Kiernan TW, Wollman J. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1: 431-5.

    Article  CAS  PubMed  Google Scholar 

  16. Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology 1994;19: 1513-20.

    Article  CAS  PubMed  Google Scholar 

  17. Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, O'Beirne J, Fox R, Skowronska A, Palmer D, Yeo W, Mo F, Lai P, Inarrairaegui M, Chan SL, Sangro B, Miksad R, Tada T, Kumada T, Toyoda H. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol 2015;33: 550-8.

    Article  PubMed  Google Scholar 

  18. Takada A, Takase S, Tsutsumi M. Characteristic features of alcoholic liver disease in Japan: a review. Gastroenterol Jpn 1993;28: 137-48.

    Article  CAS  PubMed  Google Scholar 

  19. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40: 373-83.

    Article  CAS  PubMed  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240: 205-13.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Buchler MW, Weitz J. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011;149: 680-8.

    Article  PubMed  Google Scholar 

  22. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Buchler MW, Weitz J. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 2011;149: 713-24.

    Article  PubMed  Google Scholar 

  23. Tanaka S, Shinkawa H, Tamori A, Takemura S, Takahashi S, Amano R, Kimura K, Ohira G, Kawada N, Kubo S. Surgical outcomes for hepatocellular carcinoma detected after hepatitis C virus eradiation by direct-acting antivirals. J Surg Oncol 2020;122: 1543-52.

    Article  PubMed  Google Scholar 

  24. Tanaka S, Shinkawa H, Tamori A, Takemura S, Uchida-Kobayashi S, Amano R, Kimura K, Ohira G, Nishio K, Tauchi J, Kinoshita M, Kawada N, Kubo S. Postoperative direct-acting antiviral treatment after liver resection in patients with hepatitis C virus-related hepatocellular carcinoma. Hepatol Res 2021;51: 1102-14.

    Article  CAS  PubMed  Google Scholar 

  25. Tanaka S, Tamori A, Takemura S, Hamano G, Ito T, Kawada N, Kubo S. Surgical outcomes in hepatitis C virus-related hepatocellular carcinoma: Special reference to sustained virological responses to interferon therapy. Am Surg 2017;83: 1246-55.

    Article  PubMed  Google Scholar 

  26. Koda M, Tanaka S, Takemura S, Shinkawa H, Kinoshita M, Hamano G, Ito T, Kawada N, Shibata T, Kubo S. Long-term prognostic factors after hepatic resection for hepatitis C virus-related hepatocellular carcinoma, with a special reference to viral status. Liver Cancer 2018;7: 261-76.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Holm S. A simple secuentially rejective multiple test procedure. Scand J Statist 1979;6: 65-70.

    Google Scholar 

  28. Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA 2007;298: 309-16.

    Article  CAS  PubMed  Google Scholar 

  29. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334: 693-9.

    Article  CAS  PubMed  Google Scholar 

  30. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001;33: 1394-403.

    Article  CAS  PubMed  Google Scholar 

  31. Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, Kudo M, Lee JM, Choi BI, Poon RT, Shiina S, Cheng AL, Jia JD, Obi S, Han KH, Jafri W, Chow P, Lim SG, Chawla YK, Budihusodo U, Gani RA, Lesmana CR, Putranto TA, Liaw YF, Sarin SK. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010;4: 439-74.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Tanaka S, Iida H, Ueno M, Hirokawa F, Nomi T, Nakai T, Kaibori M, Ikoma H, Eguchi H, Shinkawa H, Maehira H, Hayami S, Kubo S. Preoperative risk assessment for loss of independence following hepatic resection in elderly patients: A prospective multicenter study. Ann Surg 2021;274: e253-e61.

    Article  PubMed  Google Scholar 

  33. Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol 2005;42 Suppl: S100-7.

    Article  PubMed  Google Scholar 

  34. Durand F, Valla D. Assessment of prognosis of cirrhosis. Semin Liver Dis 2008;28: 110-22.

    Article  CAS  PubMed  Google Scholar 

  35. Wang YY, Zhong JH, Su ZY, Huang JF, Lu SD, Xiang BD, Ma L, Qi LN, Ou BN, Li LQ. Albumin-bilirubin versus Child-Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg 2016;103: 725-34.

    Article  CAS  PubMed  Google Scholar 

  36. Pinato DJ, Sharma R, Allara E, Yen C, Arizumi T, Kubota K, Bettinger D, Jang JW, Smirne C, Kim YW, Kudo M, Howell J, Ramaswami R, Burlone ME, Guerra V, Thimme R, Ishizuka M, Stebbing J, Pirisi M, Carr BI. The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. J Hepatol 2017;66: 338-46.

    Article  PubMed  Google Scholar 

  37. Hiraoka A, Kumada T, Kudo M, Hirooka M, Tsuji K, Itobayashi E, Kariyama K, Ishikawa T, Tajiri K, Ochi H, Tada T, Toyoda H, Nouso K, Joko K, Kawasaki H, Hiasa Y, Michitaka K, Real-Life Practice Experts for HCCSG, Group HCC. Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications. Liver Cancer 2017;6: 204–15.

  38. Wiboonkhwan NA, Thongkan T, Sangkhathat S, Pruphetkaew N, Pitakteerabundit T. Perioperative Outcomes of Laparoscopic Liver Resection and Risk Factors for Adverse Events. Surg Laparosc Endosc Percutan Tech 2022;32: 305-10.

    Article  PubMed  Google Scholar 

  39. Yoshikawa T, Nomi T, Hokuto D, Yasuda S, Kawaguchi C, Yamada T, Kanehiro H, Nakajima Y. Risk Factors for Postoperative Ascites in Patients Undergoing Liver Resection for Hepatocellular Carcinoma. World J Surg 2017;41: 2095-100.

    Article  PubMed  Google Scholar 

  40. Kanazawa A, Tsukamoto T, Shimizu S, Kodai S, Yamazoe S, Yamamoto S, Kubo S. Impact of laparoscopic liver resection for hepatocellular carcinoma with F4-liver cirrhosis. Surg Endosc 2013;27: 2592-7.

    Article  PubMed  Google Scholar 

  41. Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G. A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 2014;21: 745-53.

    Article  PubMed  Google Scholar 

  42. Tanaka S, Kawaguchi Y, Kubo S, Kanazawa A, Takeda Y, Hirokawa F, Nitta H, Nakajima T, Kaizu T, Kaibori M, Kojima T, Otsuka Y, Fuks D, Hasegawa K, Kokudo N, Kaneko H, Gayet B, Wakabayashi G. Validation of index-based IWATE criteria as an improved difficulty scoring system for laparoscopic liver resection. Surgery 2019;165: 731-40.

    Article  PubMed  Google Scholar 

  43. Tanaka S, Kubo S, Kanazawa A, Takeda Y, Hirokawa F, Nitta H, Nakajima T, Kaizu T, Kaneko H, Wakabayashi G. Validation of a difficulty scoring system for laparoscopic liver resection: A multicenter analysis by the Endoscopic Liver Surgery Study Group in Japan. J Am Coll Surg 2017;225: 249-58.

    Article  PubMed  Google Scholar 

  44. Harada N, Shirabe K, Ikeda Y, Korenaga D, Takenaka K, Maehara Y. Surgical management of hepatocellular carcinoma in Child-Pugh class B cirrhotic patients: hepatic resection and/or microwave coagulation therapy versus living donor liver transplantation. Ann Transplant 2012;17: 11-20.

    Article  PubMed  Google Scholar 

  45. Brytska N, Han HS, Shehta A, Yoon YS, Cho JY, Choi Y. Laparoscopic liver resection for hepatitis B and C virus-related hepatocellular carcinoma in patients with Child B or C cirrhosis. Hepatobiliary Surg Nutr 2015;4: 373-8.

    PubMed  PubMed Central  Google Scholar 

  46. Zhang Q, Wang Y, Zhang J, Zhang W, Gong J, Ma R. TACE Combined with HIFU Versus Surgical Resection for Single Hepatocellular Carcinoma with Child-Pugh B Cirrhosis in Overall Survival and Progression-Free Survival: A Retrospective Study. Technol Cancer Res Treat 2021;20: 15330338211060180.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Kobayashi A, Miyagawa S, Miwa S, Nakata T. Prognostic impact of anatomical resection on early and late intrahepatic recurrence in patients with hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 2008;15: 515-21.

    Article  PubMed  Google Scholar 

  48. Kumada T, Nakano S, Takeda I, Sugiyama K, Osada T, Kiriyama S, Sone Y, Toyoda H, Shimada S, Takahashi M, Sassa T. Patterns of recurrence after initial treatment in patients with small hepatocellular carcinoma. Hepatology 1997;25: 87-92.

    Article  CAS  PubMed  Google Scholar 

  49. Sakon M, Umeshita K, Nagano H, Eguchi H, Kishimoto S, Miyamoto A, Ohshima S, Dono K, Nakamori S, Gotoh M, Monden M. Clinical significance of hepatic resection in hepatocellular carcinoma: analysis by disease-free survival curves. Arch Surg 2000;135: 1456-9.

    Article  CAS  PubMed  Google Scholar 

  50. Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, Sugawara Y, Minagawa M, Takayama T, Kawasaki S, Makuuchi M. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol 2003;38: 200-7.

    Article  PubMed  Google Scholar 

  51. Choi KK, Kim SH, Choi SB, Lim JH, Choi GH, Choi JS, Kim KS. Portal venous invasion: the single most independent risk factor for immediate postoperative recurrence of hepatocellular carcinoma. J Gastroenterol Hepatol 2011;26: 1646-51.

    Article  PubMed  Google Scholar 

  52. Kokudo T, Hasegawa K, Matsuyama Y, Takayama T, Izumi N, Kadoya M, Kudo M, Ku Y, Sakamoto M, Nakashima O, Kaneko S, Kokudo N, Liver Cancer Study Group of J. Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. J Hepatol 2016;65: 938–43.

  53. Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, Fong Y, D'Angelica MI, Blumgart LH, Dematteo RP. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 2009;249: 617-23.

    Article  PubMed  Google Scholar 

  54. Liu L, Wang Z, Jiang S, Shao B, Liu J, Zhang S, Zhou Y, Zhou Y, Zhang Y. Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PLoS One 2013;8: e64261.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Chen GX, Qi CY, Hu WJ, Wang XH, Hua YP, Kuang M, Peng BG, Li SQ. Perioperative blood transfusion has distinct postsurgical oncologic impact on patients with different stage of hepatocellular carcinoma. BMC Cancer 2020;20: 487.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Goubran H, Sheridan D, Radosevic J, Burnouf T, Seghatchian J. Transfusion-related immunomodulation and cancer. Transfus Apher Sci 2017;56: 336-40.

    Article  PubMed  Google Scholar 

  57. Remy KE, Hall MW, Cholette J, Juffermans NP, Nicol K, Doctor A, Blumberg N, Spinella PC, Norris PJ, Dahmer MK, Muszynski JA, Pediatric Critical Care Blood Research N. Mechanisms of red blood cell transfusion-related immunomodulation. Transfusion 2018;58: 804–15.

  58. Schneider KM, Mohs A, Gui W, Galvez EJC, Candels LS, Hoenicke L, Muthukumarasamy U, Holland CH, Elfers C, Kilic K, Schneider CV, Schierwagen R, Strnad P, Wirtz TH, Marschall HU, Latz E, Lelouvier B, Saez-Rodriguez J, de Vos W, Strowig T, Trebicka J, Trautwein C. Imbalanced gut microbiota fuels hepatocellular carcinoma development by shaping the hepatic inflammatory microenvironment. Nat Commun 2022;13: 3964.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Harimoto N, Yoshizumi T, Fujimoto Y, Motomura T, Mano Y, Toshima T, Itoh S, Harada N, Ikegami T, Uchiyama H, Soejima Y, Maehara Y. Surgery for Hepatocellular Carcinoma in Patients with Child-Pugh B Cirrhosis: Hepatic Resection Versus Living Donor Liver Transplantation. World J Surg 2018;42: 2606-16.

    Article  PubMed  Google Scholar 

  60. Yao FY, Xiao L, Bass NM, Kerlan R, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging. Am J Transplant 2007;7: 2587-96.

    Article  CAS  PubMed  Google Scholar 

  61. Granito A, Bolondi L. Non-transplant therapies for patients with hepatocellular carcinoma and Child-Pugh-Turcotte class B cirrhosis. Lancet Oncol 2017;18: e101-e12.

    Article  PubMed  Google Scholar 

  62. Chan AWH, Zhong J, Berhane S, Toyoda H, Cucchetti A, Shi K, Tada T, Chong CCN, Xiang BD, Li LQ, Lai PBS, Mazzaferro V, Garcia-Finana M, Kudo M, Kumada T, Roayaie S, Johnson PJ. Development of pre and post-operative models to predict early recurrence of hepatocellular carcinoma after surgical resection. J Hepatol 2018;69: 1284-93.

    Article  PubMed  Google Scholar 

  63. Byeon J, Cho EH, Kim SB, Choi DW. Extrahepatic recurrence of hepatocellular carcinoma after curative hepatic resection. Korean J Hepatobiliary Pancreat Surg 2012;16: 93-7.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Shinkawa H, Tanaka S, Takemura S, Amano R, Kimura K, Kinoshita M, Takahashi K, Matsuzaki S, Kubo S. Nomograms predicting extra- and early intrahepatic recurrence after hepatic resection of hepatocellular carcinoma. Surgery 2021;169: 922-8.

    Article  PubMed  Google Scholar 

  65. Tanaka S, Iimuro Y, Hirano T, Hai S, Suzumura K, Fujimoto J. Outcomes of hepatic resection for large hepatocellular carcinoma: special reference to postoperative recurrence. Am Surg 2015;81: 64-73.

    Article  PubMed  Google Scholar 

  66. Lawitz E, Makara M, Akarca US, Thuluvath PJ, Preotescu LL, Varunok P, Morillas RM, Hall C, Mobashery N, Redman R, Pilot-Matias T, Vilchez RA, Hezode C. Efficacy and safety of ombitasvir, paritaprevir, and ritonavir in an open-label study of patients with genotype 1b chronic hepatitis C virus infection with and without cirrhosis. Gastroenterology 2015;149: 971-80 e1.

    Google Scholar 

  67. Poordad F, Hezode C, Trinh R, Kowdley KV, Zeuzem S, Agarwal K, Shiffman ML, Wedemeyer H, Berg T, Yoshida EM, Forns X, Lovell SS, Da Silva-Tillmann B, Collins CA, Campbell AL, Podsadecki T, Bernstein B. ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis. N Engl J Med 2014;370: 1973-82.

    Article  PubMed  Google Scholar 

  68. Reddy KR, Bourliere M, Sulkowski M, Omata M, Zeuzem S, Feld JJ, Lawitz E, Marcellin P, Welzel TM, Hyland R, Ding X, Yang J, Knox S, Pang P, Dvory-Sobol H, Subramanian GM, Symonds W, McHutchison JG, Mangia A, Gane E, Mizokami M, Pol S, Afdhal N. Ledipasvir and sofosbuvir in patients with genotype 1 hepatitis C virus infection and compensated cirrhosis: An integrated safety and efficacy analysis. Hepatology 2015;62: 79-86.

    Article  CAS  Google Scholar 

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Acknowledgements

All authors contribute to (1) substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work, (2) drafting the work or revising it critically for important intellectual content, (3) final approval of the version to be published, and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding

This study was supported by MEXT/JSPS KAKENHI (Grant Number 19K09152).

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan

    Shogo Tanaka, Hiroji Shinkawa, Takeaki Ishizawa & Shoji Kubo

  2. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan

    Takehiro Noda & Shogo Kobayashi

  3. Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan

    Koji Komeda & Fumitoshi Hirokawa

  4. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan

    Hisashi Kosaka & Masaki Kaibori

  5. Division of Gastrointestinal, Breast, and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan

    Hiroya Iida & Haruki Mori

  6. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

    Masaki Ueno & Shinya Hayami

  7. Department of Surgery, Nara Medical University, Kashihara, Nara, Japan

    Daisuke Hokuto & Ryo Morimura

  8. Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Hisashi Ikoma & Masataka Matsumoto

  9. Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan

    Takuya Nakai

  10. Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan

    Daijiro Kabata

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  1. Shogo Tanaka
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Tanaka, S., Noda, T., Komeda, K. et al. Surgical Outcomes for Hepatocellular Carcinoma in Patients with Child–Pugh Class B: a Retrospective Multicenter Study. J Gastrointest Surg 27, 283–295 (2023). https://doi.org/10.1007/s11605-022-05549-w

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