Hepatic resection can provide long-term survival of patients with non–early-stage hepatocellular carcinoma: Extending the Indication for resection?

Liver resection for intermediate hepatocellular carcinoma

“…Furthermore, surgical procedures differed significantly between these two groups, with a higher proportion of patients with minor resection in the BCLC A group than in the BCLC B group. Despite the survival advantages in the BCLC A group, the BCLC B group also achieved favorable short-and long-term survival outcomes, in accordance with other findings [35,42,43] . Regarding complications and mortality of liver re section for early and intermediate HCC, two groups of investigators did not observe differences in mortality and morbidity between patients with early and intermediate HCC after liver resection [38,44] .…”

“…Nevertheless, with advances in surgical equipment and perioperative management, we expect that survival benefits for intermediate HCC after liver resection will improve in the future. [44] Tumor size, tumor grade Tumor size, tumor grade NR NR Chang et al [43] NR Serum albumin level, ICG-15R, serum creatinine, multinodularity, Edmondson stage, macro-vascular invasion NR NR Ma et al [49] Histopathological grade, tumor capsule, tumor number, cirrhosis, BCLC classification…”

“…Another study reported that the estimated 1-, 2-, 3-and 5-year recurrence rates of patients with intermediate HCC after liver resection were 44.2%, 54.5%, 60.6% and 68.1%, respectively [43] . Variables that help predict the risk of HCC recurrence are serum albumin level, microscopic vascular invasion, multinodularity, and advanced Edmondson stage [46] .…”

“…Variables that help predict the risk of HCC recurrence are serum albumin level, microscopic vascular invasion, multinodularity, and advanced Edmondson stage [46] . Multinodularity and serum albumin level were identified as independent factors of recurrence by Chang et al [43] . Given that the incidence of HCC recurrence is fairly high, routine surveillance by computed tomography scan or magnetic resonance imaging is strongly recommended for patients with intermediate HCC after resection [47,48] .…”

Usefulness of staging systems and prognostic scores for hepatocellular carcinoma treatments

“…Advanced (BCLC C) stages encompass a broad spectrum of tumors, including cancers with or without symptoms, metastatic or locally advanced diseases, eventually associated with portal thrombosis, nodular or infiltrating tumors, uni-or multi-nodular tumors, associated with Child-Pugh A or B grade, which are, again, only associated with a single treatment (sorafenib) [24] . It has thus been suggested to extend the indication for surgery [26][27][28] or chemoembolization to some advanced stages [29,30] . Stage C HCC were defined using a population limited to 102 patients [31] .…”