Scientific Hepatectomy for Hepatocellular Carcinoma

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Hepatology

Background:

• Hepatectomy for hepatocellular carcinoma (HCC) has advanced technically, yet 5-year recurrence rates exceed 70%.
• Recurrence is primarily linked to underlying liver cirrhosis and tumor cell vascular spread, factors not fully addressed by traditional hepatectomy.
• Current strategies necessitate re-evaluation based on scientific advancements.

Purpose of the Study:

• To propose a paradigm shift from technical hepatectomy to a 'scientific hepatectomy' approach for HCC.
• To explore integrating liver cirrhosis severity assessment and systemic therapies into surgical decision-making.
• To optimize hepatectomy indications, timing, and techniques for improved patient outcomes.

Main Methods:

• Review of scientific evidence on HCC recurrence factors (cirrhosis, vascular invasion).
• Analysis of the role of liver transplantation and systemic therapies (adjuvant/neoadjuvant) in preventing recurrence.
• Conceptual framework development for 'scientific hepatectomy' integrating technical and scientific insights.

Main Results:

• Hepatectomy strategy must evolve beyond technical resection to incorporate underlying liver disease and systemic factors.
• Liver transplantation and systemic therapies offer potential solutions for eradicating non-resectable recurrence causes.
• A scientific hepatectomy approach allows for personalized optimization of treatment strategies.

Conclusions:

• Scientific hepatectomy, considering cirrhosis, vascular invasion, and systemic therapy, is crucial for improving HCC treatment.
• This integrated approach aims to decrease recurrence rates and prolong long-term survival for HCC patients.
• Personalized optimization of hepatectomy indications, timing, and techniques is the future direction.