Hepatocellular carcinoma: current surgical management

At present the only potentially curative treatment for hepatocellular carcinoma (HCC) is either partial hepatectomy or total hepatectomy with orthotopic liver transplantation (OLT). Underlying liver reserve and regenerative capacity are the most important determinants of the risk of postoperative hepatic failure after partial hepatectomy; thus, careful preoperative assessment of liver function is mandatory. In specialized centers perioperative mortality is less than 5%, although cirrhotic patients are at increased risk. Various neoadjuvant and adjuvant therapies are under investigation, but as yet there are no data that demonstrate benefit from adjuvant systemic chemotherapy. The use of OLT is limited by the difficulty of obtaining donor livers. Patients selected for transplantation and partial hepatectomy represent two distinct subgroups, but their survival after treatment is comparable. Despite the progress in the management of HCC by surgical resection, the fact remains that the majority of these patients will experience local recurrences. This has led to the development of a variety of novel new treatments that require further evaluation.