Preoperative investigation and indication for operation in hepatocellular carcinoma

Hepatocellular carcinoma remains a highly prevalent tumor in the Orient and Africa, and detection rates are now increasing in Western countries. Surgical modalities such as hepatic resection and orthotopic liver transplantation are considered the only curative treatments for patients with hepatocellular carcinoma. However, the majority of patients present with advanced disease and are unsuitable for surgical treatment. This fact emphasises the importance of screening programs, usually based on hepatic ultrasonography and measurement of alpha-fetoprotein levels, to facilitate early detection of this tumor in those patients at risk. Subsequent investigations in patients with suspicious lesions on ultrasonography and/or elevated alpha-fetoprotein levels are aimed at confirming the diagnosis of hepatocellular carcinoma, tumor staging, and assessing underlying hepatic functional reserve, thereby establishing the suitability of the patient for potentially curative surgical treatment. This paper reviews preoperative investigations and current indications for surgical treatment in patients with hepatocellular carcinoma.