Selection criteria for liver resection in patients with hepatocellular carcinoma and chronic liver disease

Abstract

H e p a t o c e l l u l a r c a rc i n o m a ( H C C ) i s o n e o f t h e most common malignancies worldwide with an annual occurrence of one million new cases. An etiologic association between HBV infection and the development of HCC has been established with a relative risk 200-fold greater than in non-infected individuals. Hepatitis C virus is also proving an important predisposing factor for this malignancy with an incidence rate of 7% at 5 years and 14% at 10 years. The prognosis depends on tumor stage and degree of liver function, which affect the tolerance to invasive treatments. Although surgical resection is generally accepted as the treatment of choice for HCC, new treatment strategies, such as local ablative therapies, transarterial embolization and liver transplantation, have been developed nowadays. With increasing detection of small HCCs from screening programs for cirrhotic patients, it is foreseen that locoregional therapy will play an important role in the near future.

Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

“…Following resection or transplant of early stage HCC, 5-year survival is around 50-70% 2 . Unfortunately, only about 30% of HCC patients are suitable, as a result of poor liver function, poor general condition and/or the locally advanced nature of HCC 3 . In patients unsuitable for transplant or resection with smaller tumours, ablative therapies such as radiofrequency ablation (RFA) may result in long term control, with 5-year survival rates over 60% for tumours <3 cm, in selected patients 4 .…”

Comparison of four radiofrequency ablation systems at two target volumes in an ex vivo bovine liver model

“…Delis and Dervenis (14) report that less than 30% of hepatocellular carcinoma patients are eligible for liver resection; thus, approximately 70% require different treatment approaches.…”

Perioperative considerations in patients with cirrhotic cardiomyopathy

“…Postoperative cardiac complications cause early morbidity and mortality in patients with cirrhosis [1][2][3][4][5][6]. Even though cardiac complications are usually seen in patients with more advanced liver disease, adverse cardiac outcomes can still occur in patients who are not as ill.…”