A Concise Review on Current Trends in Imaging and Surgical Management of Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is a primary cancer of the liver whose incidence has seen an upsurge in the United States within the last 2 decades. Despite improvements in detection and management techniques, the prognosis for patients with HCC generally remains poor. There are multiple factors that have been implicated in the etiology of HCC with cirrhosis occurring as a common final pathway. This review presents a concise summary of current trends in imaging and surgical management of HCC. An internet-based (PubMed) search using the search terms "hepatocellular carcinoma" and "imaging" and "surgical management" was performed. Our search was limited to articles related to human studies published in English during the period of 07/01/2011 to 06/30/2016. A review of all relevant articles was conducted, and findings were summarized. Modern imaging modalities employed in the diagnosis of HCC include ultrasound scan (USS), computed tomography (CT), and magnetic resonance imaging (MRI) scan. The utility of diagnostic imaging is enhanced when interpreted in conjunction with appropriate laboratory tests such as alpha-fetoprotein. The definitive treatment for HCC remains challenging; hepatic resection (HR) and liver transplantation (LT) are two approaches offering potentially curative options. For patients undergoing HR, important considerations include achieving maximum resection while maintaining optimal post-resection liver remnant volume (LRV) and functional capacity (FC), which can be assessed using 3-dimensional CT and indocyanine green clearance. Generally, an LRV of 40-50% is considered an acceptable lower limit for individuals with HCC compared to 20-30% among individuals with normal livers. With increasing knowledge of disease pathology, appropriate patient selection, coupled with advances in anesthesia and surgical technique, overall 5-year survival rates have significantly improved. Challenges associated with LT on the other hand include donor-liver shortages with resultant long wait times and continued disease progression. The scarcity of cadaveric-donor livers has led to employing living-donor livers. Ethical considerations with respect to subjecting potentially healthy donors to undue morbidity and mortality risk however remain. Additional donor-shortage circumventing strategies include employing marginal, domino, and split-organ liver transplants. For patients awaiting transplant, employing bridging therapy such as radiofrequency ablation and transhepatic artery chemoembolization might occasionally help slow disease progression and maintain transplant eligibility. Appropriate patient selection achieved through the Milan and UCSF criteria designed to guide allotment of donor livers to patients with the best chances of survival could help improve outcomes and 5-year survival rates. The main radiological options for diagnosis include USS, CT, and MRI. HR and LT are two distinct surgical options, which in practice can be used to complement one another. 1, 2, 3 3 4 5

Comparison of Hepatocellular Carcinoma in Hispanics and Non-Hispanics Patients

“…More longitudinal and ethno-racial studies will, however, be needed to tease out the nuances and confirm this hypothesis. Hispanics were more likely to receive loco-regional therapy such as RFA and TACE, which are often used as palliative treatment options in patients with advanced disease in whom tumor resection is not feasible or as a bridge to liver transplantation [30][31][32]. Explanations for this observation might include patient-related and physician-related barriers to treatment [33].…”

Circulating Tumor Cell Is a Clinical Indicator of Pretransplant Radiofrequency Ablation for Patients with Hepatocellular Carcinoma

“…e recurrence of LT within the UCSF criteria was 13.7% and it is also better than 46.4% for those beyond UCSF criteria. is indicates that Milan criteria and UCSF criteria are promising criteria for favorable outcomes [24][25][26]. However, in China, patients tend to have HR or conservative treatment due to economic or ideological reasons, even if tumors are detected early.…”

Feasibility and safety of liver resection for huge hepatocellular carcinoma in cirrhotics

“…[19][20][21] However, in the context of huge HCC in the cirrhotic liver, treatment options include liver resection, TACE, TARE and targeted therapy. [22][23][24][25] The current literature showed that in carefully selected patients with huge HCC would benefit from liver resection as upfront treatment approach. 10,[26][27][28] Likewise, several comparative studies documented the superiority of liver resection for huge HCC compared with TACE regarding overall and recurrence-free survival.…”