Introduction:
Hepatocellular carcinoma is an aggressive malignant tumor with high
lethality.
Aim:
To review diagnosis and management of hepatocellular carcinoma.
Methods:
Literature review using web databases Medline/PubMed.
Results:
Hepatocellular carcinoma is a common complication of hepatic cirrhosis.
Chronic viral hepatitis B and C also constitute as risk factors for its
development. In patients with cirrhosis, hepatocelular carcinoma usually
rises upon malignant transformation of a dysplastic regenerative nodule.
Differential diagnosis with other liver tumors is obtained through computed
tomography scan with intravenous contrast. Magnetic resonance may be helpful
in some instances. The only potentially curative treatment for
hepatocellular carcinoma is tumor resection, which may be performed through
partial liver resection or liver transplantation. Only 15% of all
hepatocellular carcinomas are amenable to operative treatment. Patients with
Child C liver cirrhosis are not amenable to partial liver resections. The
only curative treatment for hepatocellular carcinomas in patients with Child
C cirrhosis is liver transplantation. In most countries, only patients with
hepatocellular carcinoma under Milan Criteria are considered candidates to a
liver transplant.
Conclusion:
Hepatocellular carcinoma is potentially curable if discovered in its initial
stages. Medical staff should be familiar with strategies for early diagnosis
and treatment of hepatocellular carcinoma as a way to decrease mortality
associated with this malignant neoplasm.
Liver transplant (LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others. Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion. Intraoperative reinfusion of autologous blood is possible through previous self-donation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion (IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.
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