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World J Gastroenterol. Jun 7, 2021; 27(21): 2784-2794
Published online Jun 7, 2021. doi: 10.3748/wjg.v27.i21.2784
Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?
Fabrizio Romano, Marco Chiarelli, Mattia Garancini, Mauro Scotti, Mauro Zago, Gerardo Cioffi, Matilde De Simone, Ugo Cioffi
Fabrizio Romano, Department of Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
Marco Chiarelli, Mauro Zago, Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco 23900, Italy
Mattia Garancini, Mauro Scotti, Department of General Surgery, San Gerardo Hospital, Monza 20900, Italy
Gerardo Cioffi, Department of Sciences and Technologies, Università degli Studi del Sannio di Benevento, Benevento 82100, Italy
Matilde De Simone, Ugo Cioffi, Department of Surgery, University of Milan, Milano 20122, Italy
Author contributions: Romano F designed the overall concept and outline of the manuscript; Garancini M, Scotti M, and Zago M contributed to the discussion and design of the paper; Chiarelli M, Cioffi G, De Simone M, and Cioffi U contributed to writing and editing the manuscript.
Conflict-of-interest statement: The authors declare no potential conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ugo Cioffi, MD, PhD, Full Professor, Surgeon, Department of Surgery, University of Milan, Via F Sforza 35, Milano 20122, Italy. ugocioffi5@gmail.com
Received: January 24, 2021
Peer-review started: January 24, 2021
First decision: February 22, 2021
Revised: February 24, 2021
Accepted: April 29, 2021
Article in press: April 29, 2021
Published online: June 7, 2021
Processing time: 122 Days and 22.3 Hours
Core Tip

Core Tip: According to Barcelona Clinic Liver Cancer recommendations, intermediate stage hepatocellular carcinomas are excluded from surgery. Also, Child-Pugh B patients with hepatocellular carcinoma are not usually candidates for liver resection. Nevertheless, several recent studies demonstrated that surgical resection can provide good survival benefit for patients with large and multinodular (diameter > 5 cm, number > 3) hepatocellular carcinoma or Child-Pugh B cirrhosis. In this review we discuss that liver resection may improve the short- and long-term survival of selected patients who have a stage B hepatocellular carcinoma or underlying Child-Pugh B cirrhosis.