Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPBARROS, A. Z. de AlmeidaFONSECA, G. M.KRUGER, J. A. P.COELHO, F. F.HERMAN, P.2024-03-132024-03-132022JOURNAL OF GASTROINTESTINAL ONCOLOGY, v.13, n.6, p.3123-3134, 20222078-6891https://observatorio.fm.usp.br/handle/OPI/58623Background: Barcelona Clinic Liver Cancer (BCLC) is a recognized guideline to standardize treatment allocation for hepatocellular carcinoma (HCC); however, many centers criticize its restrictive liver resection recommendations and have published good results after more liberal hepatectomy indications. The objective is to evaluate the results of HCC resection in a single center, with a more liberal indication for resection than proposed by the BCLC guideline. It was performed a retrospective cohort study including all patients who underwent liver resection for HCC in a single center between April 2008 and November 2018. Methods: The results of 150 patients who underwent hepatectomy were evaluated and compared facing both 2010 and 2018 BCLC guidelines. Overall and disease-free survival after resection in patients with none, one, two, or three of the risk factors, as proposed by the BCLC, as contraindications to resection (portal hypertension, portal invasion, and more than one nodule) were analyzed. Results: Nodule size and presence of portal invasion alone did not affect prognosis. If the BCLC 2010 and 2018 guidelines were followed, 46.7% and 26.7% of the patients, respectively, would not have received potentially curative treatment. The median overall and disease-free survival for patients with one BCLC contraindication factor were 43.3 and 15.1 months, respectively. The presence of two risk factors had a negative impact on overall survival (OS) and disease-free survival (DFS), although some patients had long-term survival. The only patient with the three risk factors had a poor outcome. Conclusions: Selected patients with one BCLC contraindication factor may undergo resection with good results, whereas those with two factors should be allocated for hepatectomy only in favorable scenarios. Patients with the three risk factors do not appear to benefit from resection.engopenAccessBarcelona Clinic Liver Cancer guideline (BCLC guideline)hepatectomyHepatocellular carcinoma (HCC)liver resectiontreatmentalpha fetoproteinantineoplastic agentadultagedalcohol liver diseasealpha fetoprotein blood levelarticleascitesbile duct fistulacancer palliative therapycancer patientcancer prognosiscancer surgerycancer survivalchemoembolizationchronic liver diseaseclinical outcomecohort analysiscontrolled studydisease free survivalfemalefollow upheart infarctionhepatectomyhepatitis bhepatitis chumanhypovolemic shockliver cell carcinomaliver transplantationlong term survivalmajor clinical studymalenonalcoholic steatohepatitisoverall survivalperitonitispneumoniaportal hypertensionportal systempostoperative infectionpractice guidelineretrospective studyrisk factorseptic shocksurgical infectionsurgical mortalitysystemic therapytreatment contraindicationtumor ablationtumor invasionarticleCopyright AME PUBLISHING COMPANY10.21037/jgo-22-833