Safety assessment for hepatectomy in patients with hepatocellular carcinoma combined with hepatitis B-related cirrhosis: Expert consensus

In China, more than 80% of patients with hepatocellular carcinoma (HCC) have varying degrees of cirrhosis caused by hepatitis B virus infection. Unlike in Western countries, hepatectomy remains one of the main treatment options for patients with HCC and cirrhosis in China. The severity of cirrhosis varies considerably among individual patients with HCC. Although liver function may remain within the normal range during the compensated stage, progressive cirrhosis significantly reduces hepatic functional reserve and regenerative capacity. As a result, the incidence of postoperative complications and liver failure increases after hepatectomy. Therefore, hepatectomy that preserves as much liver parenchyma as possible is required to ensure surgical safety in patients with different degrees of cirrhosis. At present, the impact of different degrees of cirrhosis on the risk of posthepatectomy liver failure in patients with HCC is not fully understood. In addition, no consensus has been established regarding the optimal surgical approach for patients with HCC and varying severities of cirrhosis. This gap represents an important factor affecting the safety of hepatectomy. Reducing the incidence of postoperative liver failure and mortality in patients with HCC and cirrhosis remains an important issue that requires further investigation. The Chinese Chapter of the International Hepato-Pancreato-Biliary Association, Group of Liver Surgery of the Chinese Society of Surgery, invited leading domestic experts in hepatobiliary surgery and hepatology to discuss the role of cirrhosis severity in the safety assessment of hepatectomy for HCC and strategies to improve surgical safety. This consensus aims to assist hepatobiliary surgeons in making appropriate surgical decisions for patients with HCC and cirrhosis, and to improve surgical safety.