Hobeika C, Cauchy F, Sartoris R, et al. - As cirrhosis and clinically significant portal hypertension could be identified with quantification of liver surface nodularity (LSN) on routine preoperative CT images, researchers here appraised the importance of LSN in preoperative assessment of operative risks for patients with resectable hepatocellular carcinoma (HCC). They retrospectively analyzed 210 patients who were undergoing hepatectomy for HCC between 2012 and 2017. Among these, successful LSN measurement was recorded in 187 (89·0%). An increase in LSN score was observed with a hepatic venous pressure gradient, the severity of steatosis and fibrosis grade. They observed an independent correlation of LSN score was with severe complications and posthepatectomy liver failure (PHLF). After matching with respect to model for end-stage liver disease, aspartate aminotransferase-to-platelet ratio index and fibrosis-4 score, an increased risk of PHLF was retained in patients with a LSN score of 2·63 or higher. They identified the accurate predictive value of LSN for severe complications in the subgroup of patients without severe fibrosis. A higher comprehensive complication index score was recorded in patients with or without severe fibrosis with increased LSN score. An LSN value below 2·63 ruled out the risk of PHLF among patients with cirrhosis who had clinically significant portal hypertension. Outcomes thereby suggest LSN measurement as a practical tool that may assist in improving the preoperative evaluation and management of patients with HCC.