Liver resection for patients with hepatocellular carcinoma and macrovascular invasion, multiple tumours, or portal hypertension

Sir, We read with great interest the leading article by Bruix et al 1 published in Gut . This article recommended palliative treatments for patients with hepatocellular carcinoma (HCC) involving macrovascular invasion, multiple tumours, or portal hypertension. With better patient selection and improvement of perioperative care, liver resection (LR) offers the most consistent and clinically meaningful long-term survival in HCC over the past 20 years, which has been documented by both Eastern and Western centres.2 ,3 However, Western official guidelines do not recommend LR for treating intermediate and advanced stage HCC.4 ,5 Here, we systematically searched PubMed database for studies investigating the safety and efficacy of LR for treating patients with HCC involving macrovascular invasion, multiple tumours (≥2) or portal hypertension. We only included studies which were published in English on …