Hepatectomy for hepatocellular carcinoma in patients with hemophilia

Background: Hepatitis C virus infection due to contamination in large-pool clotting factor concentrate is a major co-morbidity in adult patients with hemophilia. Although the development of hepatocellular carcinoma following infection with hepatitis virus is a crucial health problem, there are few reports of hemophilia patients undergoing liver resection for hepatocellular carcinoma. Methods: Six patients with hemophilia underwent liver resection for hepatocellular carcinoma in our department from January 2003 to December 2012. We compared these hemophilic patients (H group, n = 6) to control patients without hemophilia (C group, n = 191) who underwent liver resection in the same period. Results: All six patients in the H group were hepatitis C virus positive. Administration of coagulation factors was performed perioperatively, and no differences in the operative time and estimated blood loss were observed between the groups. No postoperative complications occurred in the H group, but five patients suffered from recurrence after surgery and subsequently underwent radiofrequency ablation or transcatheter arterial chemoembolization. The median recurrence-free survival time was 17.9 months and 25.3 months in H and C group, respectively, with no significant difference between the two groups. Conclusions: Adequate replacement of coagulation factors enables hepatic resection for hepatocellular carcinoma patients with hemophilia.