Surgical management of hepatocellular carcinoma. Liver resection and liver transplantation

Abstract

Although remarkable progress has been made in the treatment of hepatocellular carcinoma HCC, local control is still the most important consideration. Liver resection is and will continue to be the first-line therapeutic modality for local control of a primary HCC, including cases with intrahepatic metastases. For a large HCC, or multiple HCCs with vascular invasion, aggressive liver resection must be pursued. In cases with poor liver functional reserve, liver transplantation would be a good therapeutic option, after considering age, and tumor-related factors. To prevent deterioration of the liver function should be the second priority in the treatment of HCC. As for liver resection, extensive removal of the non-cancerous parenchyma, such as lobectomy and hemihepatectomy, should be avoided as much as possible. Anatomic resection, which involves systematic elimination of the main tumor with its minute metastases and preserves liver function, is strongly recommended. The treatment algorithm, which is based on evidence picked up from published papers, is now available and useful to determine the therapeutic choice depending on the tumor- and liver function-related conditions.