[Surgical therapy of hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) accounts for most primary malignancies of the liver. The most important risk factor is liver cirrhosis. HCC can be traced by the tumor marker alpha-fetoprotein. Patients with a known liver cirrhosis should regularly be screened, including sonography and alpha-fetoprotein evaluation. Surgical therapy - either partial liver resection or liver transplantation - is the only treatment that can potentially achieve long-term survival. The presence of liver cirrhosis is likely to induce postoperative liver insufficiency and is associated with higher local tumor recurrence rate. Patients without liver cirrhosis or Child-Pugh A patients with tumors smaller than 5 cm may be considered as the ideal target group for resection. For more advanced stages of cirrhosis and tumors of less than 5 cm up to 7 cm in size, liver transplantation offers a better prognosis. Long waiting time for a suitable organ negatively influences liver transplantation outcome. Living donor liver transplantation is a novel therapeutic option that improves posttransplant survival and extends the indication for transplantation in hepatocellular carcinoma.