Background and purpose: The proportion of hepatocellular carcinoma (HCC) patients with cirrhosis and portal hypertension (PHT) is high. PHT may increase the risk of hemorrhage and liver failure. The aim of this study was to evaluate the safety and efficacy of liver resection (LR) for patients with HCC and PHT. Methods: From 2006 to 2010

a total of 564 HCC patients with Child-Pugh A liver function and with (78) or without PHT (486) were retrospective analyzed. Complications after surgry

30 and 90-day mortality

overall survival (OS)

and recurrence rates were compared between the two groups. Propensity score analysis was also conducted to reduce confounding bias between the groups. Moreover

subgroup analysis based on tumor stage and the range of resection was carried out. Results: The complications after surgry

30 and 90-day mortality of patients with PHT were significantly higher than those without PHT

before and after propensity analysis (P0.05). After an average follow-up of 32.1 months

the 1-

3-

5-year OS of patients with PHT (75%

45% and 32%) were significantly worse than those without PHT (90%

66% and 48%; P0.001). However

the 1-

3-

and 5-year recurrence rates were similar between PHT group (31%

57%

and 73%) and without PHT group (26%

53%

and 67%; P=0.53). Moreover

the OS of the two groups were similar after propensity analysis

and for patients with early stage HCC and those who underwent minor hepatectomy (all P0.05). Conclusion: PHT is not the contraindication of LR for patients with HCC. Those with early stage HCC and who underwent minor hepatectomy are the best candidates to LR therapy.