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Authors’ response to the letter: Liver resection for patients with hepatocellular carcinoma and macrovascular invasion, multiple tumours or portal hypertension by Zhong et al
  1. Jordi Bruix1,2,
  2. Gregory Gores3,
  3. Vincenzo Mazzaferro4
  1. 1 Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
  2. 2 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
  3. 3 Mayo Clinic, Mayo College of Medicine, Rochester, Minnesota, USA
  4. 4 Gastrointestinal Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS (National Cancer Institute), Milan, Italy
  1. Correspondence to Dr Jordi Bruix, Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, 08036, Spain; jbruix{at}clinic.ub.es

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We appreciate the opportunity to comment on the controversial issues surrounding treatment options for patients with hepatocellular carcinoma. In the field of surgery or interventional radiology it is common to emphasise technical feasibility and early morbidity/mortality rather than medium/long-term survival. Expanding life expectancy of the patients in comparison with that offered by other treatments, or even no treatment, is the goal of therapy. In our review1 and in practice guidelines2 ,3 the recommendations were based on robust data from prospective studies, preferably randomised, in the target population that had the option of being investigated. In the setting of surgical resection there are now several studies showing that presence of vascular invasion, multifocal disease and portal hypertension are associated with a …

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