Surgical Considerations for Primary Liver Neoplasms

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Primary liver neoplasms, including hepatocellular carcinoma and intrahepatic cholangiocarcinoma, represent a significant global health challenge.
• These cancers are associated with poor survival outcomes and limited effective systemic treatment options.
• Accurate preoperative assessment is crucial for determining surgical candidacy.

Purpose of the Study:

• To outline the essential components of preoperative assessment for liver neoplasms.
• To discuss the role of surgical resection and minimally invasive techniques.
• To explore strategies for managing advanced but potentially resectable liver tumors.

Main Methods:

• Comprehensive preoperative evaluation including advanced imaging, liver function tests, and future liver remnant (FLR) volumetry.
• Surgical resection aiming for negative margins.
• Application of minimally invasive surgical approaches in selected patients.
• Neoadjuvant therapies such as chemotherapy, portal vein embolization (PVE), radiation lobectomy, and hepatic artery infusion chemotherapy (HAIC) for downstaging.

Main Results:

• Surgical resection with clear margins provides the best opportunity for long-term survival in primary liver neoplasms.
• Minimally invasive surgical techniques are increasingly utilized for eligible patients, potentially reducing morbidity.
• Neoadjuvant strategies can facilitate tumor downstaging, converting initially unresectable disease into a resectable state.

Conclusions:

• Effective management of primary liver neoplasms necessitates a multidisciplinary approach integrating accurate preoperative assessment and tailored treatment strategies.
• Surgical resection remains the cornerstone of curative treatment, with advancements in surgical techniques and neoadjuvant therapies expanding resectability.
• Further research into systemic therapies and innovative downstaging techniques is warranted to improve outcomes for patients with advanced liver cancer.