The surgical approach to HCC: Our progress and results in Japan

Abstract

Due to the prevalence of hepatitis virus infection, the incidence of hepatocellular carcinoma (HCC) is very high in Japan. Many techniques have been devised by Japanese surgeons to reduce the mortality rate after hepatectomy for HCC: preoperative precise evaluation of hepatic functional reserve, portal venous embolization as preoperative preparation, anatomical and nonanatomical limited resections using intraoperative ultrasonography, and intermittent inflow occlusion during liver transection. Several challenging surgical procedures are also being tried for advanced HCC: HCC with portal and hepatic venous tumor thrombus, multiple and/or recurrent HCC, and HCC in the caudate lobe. As a result, the latest national survey of HCC revealed that operative mortality was 0.9% and the 5-year survival rate after surgery was 52%. Living-donor liver transplantation for adult patients with HCC is another surgical treatment developed in Japan. After the success of adult-to-adult living donor liver transplant using a left liver graft in 1993, a right liver graft, a left liver graft with caudate lobe, and a right lateral sector graft were developed. Indications for reconstructing the middle hepatic vein tributaries in right liver grafts were also proposed. Consequently, in our series of 36 patients with HCC who underwent living-donor liver transplantation, operative mortality was 3%, and the 2-year survival rate was 84%.

Management of hepatocellular carcinoma: Enlightening the gray zones

“…In fact, perioperative mortality in cirrhotics after HCC resection is about 2%-3%. Moreover, there is a risk of tumor recurrence af-ter surgery of about 70% at 5 years, enclosing both true recurrence and the novo tumours [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] . Percutaneous local ablation, namely radiofrequency ablation (RFA) and ethanol injection (EI) are the standard of care for BCLC O-A not suitable for surgery.…”

Diabetes Worsens the Surgical Outcomes in Cirrhotic Patients with Hepatocellular Carcinoma

“…Recently, remarkable progresses in diagnostic and treatment techniques have improved the prognosis of patients with HCC (Jacqes and Reza 2005). Surgical treatment nowadays is safer and achieves an acceptable overall mortality rate of < 5% and a good long-term survival of up to > 50% in cirrhotic patients (Makuuchi and Sano 2004). However, the incidence of post-treatment recurrence remains high, with a 5-year recurrence rate of > 60% (Imamura et al 1999;Fan et al 1999).…”

Liver transplantation and expanded Milan criteria: does it really work?

“…Several studies have shown that some tumor patients transplanted outside of the UNOS and MC survive longer (9,12,16,17,18,36,44,52) and as consequence, several proposals have been made to expand the HCC inclusion criteria (18,28,63,64,65) . However, the criteria proposed by the University of Pittsburgh and some groups in Europe are based, at least in part, on pathological features (nodal invasion, grade, vascular invasion) that are not usually available before transplantation (9,21,50,68) .…”