Hepatocellular cancer: resection or transplantation

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Hepatocellular carcinoma (HCC) management varies based on tumor stage and liver status.
• Resection is the standard for HCC without cirrhosis, with prognosis tied to tumor characteristics.
• Liver transplantation's role in non-cirrhotic HCC is limited, and it's not recommended for unresectable advanced disease.

Purpose of the Study:

• To outline the surgical treatment strategies for hepatocellular carcinoma (HCC).
• To compare resection versus liver transplantation for HCC based on patient and tumor factors.
• To define the optimal approach for HCC in both cirrhotic and non-cirrhotic liver disease.

Main Methods:

• Review of surgical treatment options for hepatocellular carcinoma (HCC).
• Analysis of prognostic factors influencing survival after HCC resection.
• Evaluation of liver transplantation as a treatment for HCC in cirrhotic and non-cirrhotic patients.

Main Results:

• For HCC without cirrhosis, prognosis improves with smaller tumors (<5 cm), solitary lesions, negative margins, and no vascular invasion.
• In cirrhotic patients, surgical decisions depend on tumor stage and liver function; resection outcomes are good for well-preserved function but limited by recurrence and decompensation.
• Liver transplantation offers superior long-term outcomes for small, cirrhosis-related HCCs compared to resection, particularly in younger patients.

Conclusions:

• Resection is the mainstay for non-cirrhotic HCC, with outcomes dependent on tumor characteristics.
• For cirrhotic HCC, liver transplantation is the preferred option for small tumors, offering better long-term survival than resection.
• Surgical management of HCC requires careful consideration of tumor stage, liver function, and treatment availability.