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Published on: September 30, 2021
Hepatobiliary malignancies: lessons from Asia
Tiffany C L Wong1, Ronnie T P Poon
1Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Insights
Asian centers offer advanced treatments for liver cancer (HCC) and bile duct cancer (CCA), differing from Western approaches. Collaboration is key to optimizing strategies for these hepatobiliary malignancies.
Area of Science:
- Hepatobiliary Malignancies
- Surgical Oncology
- Gastroenterology
Background:
- Higher incidence of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) in Asia compared to the West.
- Hepatitis B is the primary HCC risk factor in Asia, unlike hepatitis C in Western populations.
- Western Barcelona Clinic for Liver Cancer (BCLC) staging is often deemed too conservative by Asian centers.
Purpose of the Study:
- To highlight the significant contributions of Asian centers to managing HCC and CCA.
- To compare and contrast Eastern and Western treatment strategies for hepatobiliary malignancies.
- To advocate for international collaboration in advancing treatment protocols.
Main Methods:
- Review of current management practices in Asian and Western centers for HCC and CCA.
- Analysis of differences in surgical approaches, including resection and transplantation criteria.
- Examination of pioneering techniques such as living donor liver transplantation in Asia.
Main Results:
- Asian centers employ more extended criteria for liver resection and transplantation in HCC.
- Living donor liver transplantation is crucial in Asia for HCC management due to graft scarcity.
- Asian centers adopt aggressive surgical strategies for CCA, including radical lymphadenectomy and combined vascular resections.
Conclusions:
- Asian centers provide innovative and aggressive management for HCC and CCA.
- Divergent approaches in Asia and the West necessitate further collaborative research.
- Optimizing treatment strategies for hepatobiliary malignancies requires integrating Eastern and Western expertise.
Abstract:
With the higher incidences of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) in the East compared with the West, Asian centers have made significant contributions to the management of these malignancies. The major risk factor for HCC is hepatitis B infection in Asia in contrast to hepatitis C in Western populations. Barcelona Clinic for Liver Cancer (BCLC) staging that guides the treatment of patients with HCC in the West is considered too conservative by many Asian centers. In Asia, liver resection is widely offered to patients with multifocal, bilobar tumor or tumor invasion to the portal vein. The criteria for liver transplantation for HCC are also often more extended in Asian centers. Asian surgeons pioneered the development of living donor liver transplantation, which plays a major role in the management of early HCC associated with severe cirrhosis in Asia due to shortage of deceased donor graft. Asian centers have also made significant contributions to the modern management of CCA. A more aggressive surgical approach is generally adopted in Asia, including radical lymphadenectomy for intrahepatic CCA and simultaneous hepatic artery and portal vein resection with hepatectomy for hilar CCA. Eastern and Western centers should collaborate in further studies to establish the optimal treatment strategies for hepatobiliary malignancies.
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