Conclusion: GPB reduced

HE events as well as ammonia in patients with cirrhosis and HE and its safety profile was similar to placebo. The findings implicate ammonia in the pathogenesis of HE and suggest that GPB has therapeutic potential in this population. (Clinicaltrials.gov, NCT00999167). (Hepatology 2014;59:1073-1083) “
“SURGERY IS THE most reliable local control treatment for tumor removal; however, MAPK inhibitor the assurance that its safety is not inferior to other treatments is required. Lately, the safety of hepatectomy has improved to a level comparable to that of general gastroenterological surgery. According to the 17th Nationwide Follow-up Survey of Primary Liver Cancer (2002–2003) by the Liver Cancer Study Group of Japan, operative mortality is reported to be 0.8%, and the 5-year survival rate is 53.4% (LF120891). These rates were achieved by integration of preoperative evaluation, surgical techniques and management in the perioperative period. For determining whether surgery is indicated, evaluations of the extent of the hepatocellular carcinoma and liver function are essential. The stage

of hepatocellular carcinoma is defined by tumor size and tumor number, and the Tipifarnib clinical trial presence or absence of vascular invasion, lymph node metastasis and distant metastasis. For assessing the appropriateness of the indications of surgery based on liver function, easier and more highly accurate criteria have been proposed and have come into widespread use. For surgical techniques, various procedures found to be appropriate from both the perspective of radical tumor treatment and that of preservation of liver function have been developed in Japan. In the future, evidence of the improvement of long-term prognosis such as recurrence-free survival and cumulative survival, and evidence of adjuvant therapy need to be accumulated. In this revision, we examined items reflecting the current condition and comprised sections concerning indication for surgery/surgical procedures/treatment for recurrence (three clinical MCE questions [CQ]: one CQ reduced), prognostic factors (three CQ), management of the perioperative period

(two CQ) and adjuvant therapy (two CQ). In addition, liver transplantation (from a living donor) was covered by the National Health Insurance in 2004 and has since become common as a new surgical therapy for hepatocellular carcinoma. Japan is the world leader in living donor liver transplantation, and results for hepatocellular carcinoma have been pooled as evidence. In this revised version, the four CQ on transplantation are newly added. We searched articles from the MEDLINE database (Dialog system) using four key words including “hepatocellular carcinoma”, “surgery”, “English original articles” and “1980 to 2007” and selected 1481 articles. Then, 121 (8.2%) highly reliable articles were selected after primary to tertiary selection.