Background Selection criteria for hepatectomy for hepatocellular carcinoma (HCC) are object of debate. We presented our criteria for safe hepatectomy for HCC, and we compared the results with those obtainable using the most common scores for HCC. Methods All patients submitted to hepatectomy for HCC based on the same criteria were reviewed from our prospectively maintained database. Such criteria included bilirubin (BIL), cholinesterases (CHE), ascites, esophageal varices, and residual liver volume. Results A total of 336 patients were analyzed. One hundred fifteen patients (33%) had thoracoabdominal approach, but only 39 (12%) had major or extended resections. The median tumor number was 1 (range 1-33), while the median tumor size was 3.6 cm (range 1.1-28). Of those, 94 (29%) had postoperative complications, of which 6% were graded as major (Dindo III-IV). The 90-days mortality was 2%. The MELD, APRI, and CPT scores were not found to be statistically significant for complications, while combining BIL and CHE we defined four classes of risk. The association of BIL > 1 mg/dl (>17.1 μol/l) and CHE ≤5,900 U/l was the best to detect complications (OR = 4.45; P = 0.007). Conclusions This study shows that our selection criteria that count mainly on two commonly available, and inexpensive parameters, BIL and CHE, lead to identify patients potentially at risk of postoperative complications after hepatic resection for HCC. Registration number: NCT02056041 (http://www.clinicaltrials.gov).
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