East meets the West-portal pressure predicts outcome of surgical resection for hepatocellular carcinoma

Surgical resection for hepatocellular carcinoma is a safe treatment if proper selection criteria and state-of-the-art surgical techniques are applied. In surgical candidates with the same Child-Pugh classification, long-term outcome after resection depends on the presence of portal hypertension and multifocality of the tumor. Best outcomes are achieved in patients with a single hepatocellular carcinoma and no portal hypertension, the presence of which can be accurately established by hepatic vein catheterization or indirectly inferred by findings such as low platelet count, splenomegaly and esophageal varices. Patients with multiple hepatocellular carcinoma and/or portal hypertension have, by contrast, a significantly lower survival rate. Results from the study by Ishizawa et al. carried out in a Japanese institution ultimately validate Western studies. East and West can now share criteria to select the best candidates for surgery, and consider for the nonoptimal cases those other options that might offer better outcomes (transplantation) or similar outcomes to surgery with lower invasiveness and cost (ablation).