Asia-Pacific modified Delphi consensus conference on large hepatocellular carcinoma

Adianto Nugroho ¹, Arnetta N Lalisang ², Toar J M Lalisang ²

¹Indonesian Society of Digestive Surgeons, Indonesia; Department of Surgery, Fatmawati Central General Hospital, Jakarta, Indonesia.
²Indonesian Society of Digestive Surgeons, Indonesia; Department of Surgery, Faculty of Medicine, Universitas Indonesia, dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
³Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Center, Bharat Institute of Higher Education & Research, Chennai, Tamil Nadu, India; Institute of Liver Disease and Transplantations, Gleneagles Global Health City, Chennai, India; Institute of Liver Studies, King's College Hospital, London, UK.
⁴Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore; Department of Surgery and Surgical Oncology, National Cancer Center, Singapore.
⁵Department of Surgery, National University Hospital, Singapore.
⁶Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁷Hepatobiliary and Pancreatic Surgery Department, Yangon Specialty Hospital, University of Medicine 1, Yangon, Myanmar.
⁸Liver Center, National Kidney and Transplant Institute, Philippines.
⁹Hepato-Pancreato-Biliary Surgery Unit, Department of Surgery, National Cancer Institute, Bangkok, Thailand.
¹⁰Indonesian Society of Digestive Surgeons, Indonesia; Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
¹¹Liver Tumor Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.
¹²Department of Surgery, Hepato-Biliary Pancreatic Surgery Division, National Center for Global Health and Medicine, Tokyo, Japan.
¹³Section of Hepato-Pancreato-Biliary Surgery, Makati Medical Center, Makati, Philippines; Section of Hepatobiliary Pancreatic Surgery, Surgical Oncology, and Minimally Invasive Surgery, St Luke's Medical Center, Quezon City, Philippines; Liver Center, National Kidney and Transplant Institute, Quezon City, Philippines.

⁰Indonesian Society of Digestive Surgeons, Indonesia; Department of Surgery, Fatmawati Central General Hospital, Jakarta, Indonesia.

Hpb : the Official Journal of the International Hepato Pancreato Biliary Association +

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August 12, 2025

View abstract on PubMed

Summary

Management of large hepatocellular carcinoma (HCC), defined as nodules ≥5 cm, lacks standardized guidelines. This consensus provides recommendations for optimal surgical strategies and diagnosis in the Asia-Pacific region.

Area Of Science

Hepatobiliary Surgery
Surgical Oncology
Gastroenterology

Background

Primary liver cancer, particularly large hepatocellular carcinoma (HCC), is a leading cause of cancer mortality in the Asia-Pacific region.
Optimal management strategies for large HCC remain undefined, necessitating consensus-based guidelines.

Purpose Of The Study

To establish a consensus on the definition and standardized management of large hepatocellular carcinoma (HCC).
To provide guidance for surgeons managing large HCC, especially in the Asia-Pacific region.

Main Methods

Modified Delphi method involving three survey rounds and a discussion panel.
Anonymous contributions from 31 experts to refine statements and achieve consensus on large HCC management.

Main Results

Large HCC is defined as a nodule measuring ≥5 cm.
A distinct BCLC staging system is recommended for solitary large HCC (SLHCC) without vascular invasion or dissemination.
Multiphasic contrast-enhanced CT/MRI and AFP levels ≥400 aid in SLHCC diagnosis; portal vein tumor thrombosis (PVTT) is a critical prognostic factor.
Major hepatectomy and laparoscopic approaches are viable for SLHCC, with essential postoperative radiological surveillance.

Conclusions

Tailoring surgical approaches, ensuring operational readiness, and optimizing resources are crucial for successful large HCC management.
The consensus provides a framework to guide surgeons in managing large HCC effectively.