Hepatocellular carcinoma surgical therapy: perspectives on the current limits to resection

Hepatocellular carcinoma (HCC) patients often present with late stage disease, which removes surgical resection from the therapeutic treatment options. Only patients with very early disease are recommended for a potentially curative surgical resection. These guidelines have been broadly challenged due to the lack of evidence supporting the use of local therapies over surgery for resectable disease. This review highlights the role of surgical resection for HCC by disease stage, and reports data that supports treatment outside of the accepted Barcelona Clinic Liver Cancer (BCLC) treatment algorithm. As such, the role for surgery in advanced disease is also reviewed. We also highlight the limitations of surgical resection for HCC. With the available data, it is crucial that an update of the current clinical guidelines be introduced, as the current guidelines prohibit the benefit of surgical resection to patients who may be able to achieve a survival benefit.