[Surgical treatment of hepatocellular carcinoma]

There are two principal aspects to surgical treatment of hepatocellular carcinoma, hepatectomy and transplantation. Transplantation is a treatment of the tumor and the underlying liver disease. When discovered in a <> liver, hepatocellular carcinoma is often seen as a large tumor. Resection is indicated if there is no bilobar diffusion or metastasis. If the liver is <>, liver resection is contraindicated in case of liver failure or atrophy. In patients with no liver failure (Child-Pugh A), bi-segmentary resection can be proposed. In the long run, the causes of mortality after resection for hepatocellular carcinoma are mainly subsequent to tumor recurrence. Transplantation is a priori the best possible treatment for small sized hepatocellular carcinoma developing on a chronically ill liver. For several reasons, this option cannot however be proposed for all patients: limited number of liver grafts available, high operative mortality around 10%. In addition, the risk of recurrence of the causal liver disease, particularly in case of hepatitis B and C infections, is high. Finally, even if the initial tumor is a unique small-sized lesion, the risk of recurrence is favored by the immunosuppression required for tolerance after liver transplantation.