Current status of surgery and transplantation in the management of hepatocellular carcinoma: an overview

Abstract

Despite many therapeutic advances in the field of hepatocellular carcinoma over the past two decades, this disease continues to be a major cause of cancer-related mortality worldwide. This review focuses on the recent advances in surgical technique, perioperative management, and transplantation of cirrhotic and noncirrhotic patients with hepatocellular carcinoma. Liver resection continues to be the mainstay of curative treatment in noncirrhotic patients and selected cirrhotic patients with small tumors and preserved liver function. Transplantation should be advocated for patients with poor liver function and localized lesions or for patients with large fibrolamellar carcinomas that are otherwise unresectable. Surgery has a definite role in the management of hepatic recurrences in the absence of systemic dissemination. Newer advances in the therapeutic armamentarium, such as cryotherapy, radiofrequency ablation, microwave coagulation, and ethanol injections are discussed, and their overall efficacy assessed.

Diagnosis of hepatocellular carcinoma

“…Each year 500 000 to 1 million individuals are diagnosed with hepatocellular carcinoma (HCC) worldwide 1. Incidence rates demonstrate dramatic geographic variability, ranging from <5 new cases per 100 000 persons per year in developed western countries to >100 per 100 000 persons per year in parts of south‐east Asia and sub‐Saharan Africa 2. Although the United States is among regions of low incidence, a 70% increase in HCC has been observed over the past two decades, apparently related to the emergence of chronic hepatitis C 3.…”

Surgical treatment of hepatocellular carcinoma: Similar long-term results despite geographic variations

“…3 Even higher rates of Ͼ100 per 100,000 have been reported from southeast Asian countries and sub-Saharan African countries, where the incidence parallels the high incidence of hepatitis B carriers. 4 Although the incidence of HCC is relatively low in the United States, the incidence has increased throughout the last decade. 5,6 Because of geographic variations in incidence and etiology, several authors have suggested that HCC in different regions of the world may represent different forms of the disease.…”

Idiopathic extensive peliosis hepatis treated with liver transplantation

“…The present case is the first reported case of idiopathic extensive peliosis hepatis with irreversible liver insufficiency and cirrhosis. In such a catastrophic situation, orthotopic liver transplantation seems to be the only life‐saving treatment …”