Liver resection of hepatocellular carcinoma in patients with portal hypertension and multiple tumors

Aim Liver resection for hepatocellular carcinoma (HCC) has been recommended only for patients with a single tumor without portal hypertension. We aimed to validate this treatment strategy that is based on by the Barcelona Clinic Liver Cancer staging system. Methods Patients undergoing liver resection were divided into two groups: patients with single HCC without portal hypertension (Group 1) and those with at least one factors of portal hypertension and multiple tumors, up to three lesions each ≤3 cm (Group 2). We compared survival and postoperative complications between the two groups. Results The median overall and recurrence‐free survival periods of patients in Group 1 (n = 695) were 8.5 years (95% confidence interval [CI], 6.6–9.0) and 2.4 years (2.2–2.7), respectively, and were significantly longer compared with those of patients in Group 2 (n = 197) (5.6 years [95% CI, 4.8–6.7], P = 0.001, and 1.9 years [1.6–2.1], P