Hepatocellular carcinoma in the modern era: transplantation, ablation, open surgery or minimally invasive surgery? -A...

Hepatocellular carcinoma (HCC) is one of the few gastrointestinal cancers with increasing incidence and mortality worldwide. It arises most frequently in the setting of cirrhosis and presents heterogeneously with varying degrees of preserved liver function. Surgical resection and liver transplantation represent the cornerstones of curative treatment worldwide, whereas tumor ablation is being increasingly used for small tumors. A variety of different treatment algorithms have been developed, taking into consideration both the tumor stage as well as the liver reserve. Currently, many treatment modalities are continuously evolving. Transplantation criteria are expanding and even higher stage tumors become transplantable with neoadjuvant treatment. Surgical resection is being affected by the introduction of minimally invasive approaches. Ablation techniques are increasingly being used for small tumors. Combinations of different treatments are being introduced such as surgical resection followed by salvage transplantation. In this continuously changing field, the objectives of this review are to summarize the current curative surgical treatment options for patients with HCC, focusing on the controversial areas that multiple treatments might be applicable for the same patient, highlight the recent advances in minimally invasive surgery for HCC, and emphasize the need for a multidisciplinary approach and treatment plan tailored to the characteristics of each patient.