[Perspective of standardization of surgical treatment for hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) is one of the most common malignancies in Japan and worldwide. In recent years, surgical treatment for this disease has made great progress, leading to reduced operative morbidity and mortality. The advances have made it feasible to standardize surgical treatment. Moreover, the public deserves quality treatment ensured by surgical expertise. In these circumstances, the author believes that the following are important issues in the standardization of surgical therapy. 1) Surgical indications and evaluation of hepatic functional reserve, for which the Makuuchi criteria appear useful in principle, must be standardized. 2) The surgical method must be determined. Anatomically systematized resection may be reasonable, although nonanatomical resection may be performed when resection of less extent than the Healey segment is performed. 3) A consensus must be reached on pre- and postoperative adjuvant chemotherapy. Interferon administration liver transplantation may be a promising prophylactic therapy against hepatitis C-related HCC recurrence after curative resection. 4) It is necessary to clarify the long-term survival rate of patients with small HCC who undergo radiofrequency ablation in relation to tumor size, associated liver disease, tumor differentiation, tumor vascularity, etc. Appropriate treatment should be based on an analysis of these four factors. In addition, the issues of surgical indications for vascular tumor thrombus, preoperative portal branch embolization, laparascopic hepatectomy, and also liver transplantation should be discussed, along with perioperative management and postoperative follow-up.