Hepatocellular carcinoma: current surgical management.

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Liver Transplantation

Background:

• Hepatocellular carcinoma (HCC) management relies on surgical interventions like partial hepatectomy and orthotopic liver transplantation (OLT) for curative potential.
• Assessing liver reserve and regenerative capacity is critical for predicting postoperative hepatic failure risk after partial hepatectomy.
• While perioperative mortality is low in specialized centers, cirrhotic patients face elevated risks.

Purpose of the Study:

• To review current curative treatment options for hepatocellular carcinoma (HCC).
• To highlight the importance of preoperative liver function assessment in surgical candidates.
• To discuss the limitations and future directions in HCC management.

Main Methods:

• Review of current literature on surgical management of HCC.
• Analysis of factors influencing outcomes after partial hepatectomy and OLT.
• Evaluation of neoadjuvant, adjuvant, and novel treatment strategies.

Main Results:

• Partial hepatectomy and OLT offer comparable survival rates for selected HCC patient subgroups.
• Adjuvant systemic chemotherapy has not demonstrated significant benefit in current studies.
• Donor liver scarcity limits the application of OLT.
• Local recurrence remains a significant challenge post-surgical resection.

Conclusions:

• Surgical resection and OLT are primary curative treatments for HCC, necessitating thorough preoperative evaluation.
• Despite advancements, managing local recurrences in HCC requires further investigation into novel therapeutic approaches.
• Optimizing patient selection and exploring innovative treatments are key to improving HCC outcomes.