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Updated: May 27, 2025

Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
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[Conversion Surgery for Initially Unresectable Hepatocellular Carcinoma].

Takamichi Ishii1, Tomoaki Yoh, Takahiro Nishio

  • 1Dept. of Surgery, Graduate School of Medicine, Kyoto University.

Gan to Kagaku Ryoho. Cancer & Chemotherapy
|February 17, 2025
PubMed
Summary

Conversion surgery for hepatocellular carcinoma (HCC) is now common due to advanced therapies. New Japanese guidelines classify HCC resectability, aiding treatment decisions for this liver cancer.

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Area of Science:

  • Hepatobiliary surgery
  • Surgical oncology
  • Hepatocellular carcinoma research

Context:

  • Conversion surgery, initially unresectable tumors made operable by multidisciplinary treatment, is increasingly utilized for hepatocellular carcinoma (HCC).
  • The advent of effective therapies like immune checkpoint inhibitors has significantly impacted HCC management.
  • Recent Japanese Expert Consensus 2023 provides standardized oncological criteria for HCC resectability, addressing prior ambiguity.

Purpose:

  • To outline the updated Japanese Expert Consensus 2023 criteria for hepatocellular carcinoma (HCC) resectability.
  • To establish a common terminology for defining unresectable HCC.
  • To categorize HCC cases based on tumor characteristics and predict surgical candidacy.

Summary:

  • HCC cases are now classified into three categories: R (resectable), BR1 (borderline resectable 1), and BR2 (borderline resectable 2).
  • Classification is based on tumor number, size, vascular invasion, and extrahepatic involvement.
  • These criteria aim to guide surgical indications within a multidisciplinary treatment framework for HCC.

Impact:

  • Standardized criteria facilitate clearer communication and decision-making in conversion surgery for HCC.
  • Improved classification may lead to more appropriate patient selection for surgical intervention.
  • Further research is needed to confirm the prognostic benefits of conversion surgery following successful non-surgical treatments.