Surgical Resection of Hepatocellular Carcinoma

BACKGROUND: Surgical management of hepatocellular carcinoma is challenging. Advances in patient selection and operative techniques are taking place in various parts of the world. METHODS: The literature on diagnosis, evaluation, and surgical treatment of hepatocellular carcinoma is reviewed and combined with the extensive clinical experience of the authors. RESULTS: While alpha-fetoprotein levels often are elevated in patients with large hepatocellular tumors, a combination of hepatic arteriography and Lipiodol computed tomography is the most sensitive imaging approach. An indocyanine green retention of more than 14% at 15 minutes predicts a poor outcome from surgery. Intraoperative ultrasound and ultrasonic dissector assist surgery. One-, three-, and five-year survival rates of 68%, 44%, and 35%, respectively, have been reported. CONCLUSIONS: Methods to diagnose and assess the suitability of patients with hepatocellular carcinoma for surgical resection are now available, and operative and postoperative care has improved. Surgery remains the "gold standard" to which other treatments can be compared.