Resection for Hepatocellular Carcinoma

Abstract

Hepatocellular Carcinoma (HCC) continues to present major challenges in management, which is further complicated by the presence of associated chronic liver disease. Key issues in surgical resection of HCC include the site, size, and number of lesions, the severity of the chronic liver disease, and the size of the functional liver remnant. De novo HCC in the absence of chronic liver disease can be treated by major liver resection with little risk of postoperative liver failure. Liver resection can also be used a bridge to liver transplantation as it affords the possibility of determining the pathologic grade of the tumortumor and its invasiveness, and thereby the prognosis. This review summarizes the current treatment approaches to surgical resection for HCC. ( J CLIN EXP HEPATOL 2014;4:S90-S96) R ecommendations for treatment of HCC should be based on randomized controlled trials or meta analyses, rather than by non randomized clinical trials or observational studies. However, there is a paucity of robust evidence regarding the treatment of HCC. Interventions have not been thoroughly tested against each other. Hence the strength of evidence for most interventions is less than desirable. Therefore treatment decisions must be taken by a multi-disciplinary group which comprises hepatologists, surgeons, radiologists, interventional radiologists, pathologists, nurses, palliative care physicians, patient education specialists, and pharmacists. Treatment decisions must be made in a tumortumor board meeting.In India, the problem is compounded by the fact that the country is large, and there is considerable variation in the expertise and technology available for the treatment of HCC. It is inconceivable that HCC shall be treated only in a few centers with state-of-the art services. While treatment guidelines must therefore be treated with caution, the right of every patient with HCC to standardized care has placed a huge burden on healthcare systems to deliver for these patients. Although prevention of HBV related cancer is still the priority, yet, treatment of the established HCC is also necessity.The radical treatment options are: No randomized data is available at this time comparing these three approaches. Hence existing guidelines are dependent on cure rates with these treatment approaches. HEPATOCELLULAR CARCINOMA IN THE ABSENCE OF LIVER DISEASEHCC in background of healthy liver (without cirrhosis or chronic hepatitis) may occur occasionally.1 There are two types: a) the classical sporadic variety, and b) the fibrolamellar variant. The fibrolamellar variant is characteristic in the female preponderance, absence of AFP elevation, and in the presence of lymph node involvement. These tumors present only as mass lesions and at an advanced stage. Despite this advanced stage at presentation, resection can be done as the healthy liver has a normal ability to regenerate. Survival following resection is over 50% at 5 years. 2 HEPATOCELLULAR CARCINOMA IN THE PRESENCE OF LIVER DISEASEResection for HCC has several advantages: ...

Synergistic effect of farnesyl transferase inhibitor lonafarnib combined with chemotherapeutic agents against the growth of hepatocellular carcinoma cells

“…The lack of secondary therapeutic options is clinically problematic. Only 20% of HCC patients are eligible for radical therapy comprising hepatectomy or liver transplantation, and even if a radical cure is achieved in HCC, the recurrence rate is high owing to the underlying liver diseases [ 31 ]. Thus, the majority of HCC patients eventually require systemic chemotherapy, and thus it is urgently needed to discover novel effective drugs for HCC treatment [ 32 , 33 ].…”

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

“…Daniel Cherqui published first series of major liver resection in 2000 (24). A review on robotic liver surgery revealed that major hepatectomies such as right hepatectomy were performed only in specialized centers; 33 out of 51 right liver resections were performed by Giulianotti and his team (25)(26)(27).…”

Prediction of early recurrence of hepatocellular carcinoma within the Milan criteria after radical resection

“…While according to the previous reports, 50 percent of early stage HCC patients could recur within three years after radical resection (RR) [ 1 , 2 ]. But currently the concept of early stage HCC remains little inconsistent due to the risk of recurrence after treatments varied depending on the defined thresholds of tumor diameters [ 3 , 4 , 5 ], however, majority of the patient groups were selected according to the Milan criteria (MC) which is based on the macro-morphological criteria [ 6 ].…”