Resection for hepatocellular cancer: overpassing old barriers

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Current selection criteria for liver resection (LR) in hepatocellular cancer (HCC) may be overly restrictive.
• Recent evidence suggests LR can be safely extended to patients with certain negative prognostic factors.

Purpose of the Study:

• To review existing literature on the safety and efficacy of LR for HCC in patients with risk factors.
• To identify specific variables that were previously considered contraindications for LR.

Main Methods:

• Systematic review of studies investigating patient selection for LR in HCC.
• Analysis of specific variables including age, disease status, nodule size, hyperbilirubinemia, portal hypertension, Child-Pugh status, and macrovascular invasion.

Main Results:

• No single investigated factor (age, comorbidities, nodule size, hyperbilirubinemia, portal hypertension, Child-Pugh status, macrovascular invasion) was found to be an absolute contraindication for LR.
• LR is a safe and effective treatment for HCC-on-cirrhosis in selected patients with one or more risk factors.

Conclusions:

• Liver resection for HCC is feasible and safe in patients with specific risk factors, challenging traditional restrictive criteria.
• The presence of multiple contemporaneous risk factors may still contraindicate LR, warranting careful case-by-case evaluation.
• Further research into borderline cases, potentially exploring the role of laparoscopy, is needed to refine patient selection for liver resection.