When Resectability Emerges After Systemic Therapy in Hepatocellular Carcinoma: A Proposed Response-Guided...

Area of Science:

• Hepatobiliary surgery
• Medical oncology
• Translational research

Background:

• Immune checkpoint inhibitor combinations can render initially unresectable hepatocellular carcinoma (HCC) resectable.
• The optimal management strategy following conversion therapy remains uncertain.

Purpose of the Study:

• To review evidence on surgical consolidation after conversion therapy for HCC.
• To propose a response-guided framework for post-conversion decision-making.

Main Methods:

• Review of retrospective comparative studies and emerging randomized data.
• Development of a conceptual framework based on response depth and other factors.

Main Results:

• Surgical consolidation is feasible and may improve progression-related outcomes in selected HCC responders.
• Definitive survival benefit across all response categories is unproven.
• Partial response is a consistent indicator for surgery; stable and complete responses require further stratification.

Conclusions:

• Post-conversion resectability is a therapeutic decision point, not just a surgical endpoint.
• Multidisciplinary assessment including anatomical feasibility, response, hepatic reserve, and biological risk is crucial.
• A prospective validation of the proposed response-guided framework is necessary.