Current topics in the surgical treatments for hepatocellular carcinoma

Abstract

Treatment strategy for hepatocellular carcinoma (HCC) requires optimal selection of therapies based on various factors related to tumor condition and liver functional reserve. Although several evidence‐based guidelines have been proposed for the treatment of HCC, the criteria and range of indications differ among these guidelines according to the circumstances of each country. In European nations and the USA, patients with the Barcelona Clinic Liver Cancer stage 0‐A are subjects for surgical resection, whereas in Asian countries, even those with the intermediate stage are regarded as surgical candidates. Furthermore, since the recent introduction and rapidly widely spreading use of laparoscopic liver resection, this technique has become an important treatment option for surgical resection. In this review article, we overview the current topics of treatment of HCC with a special focus on surgical therapy.

Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

“…The present findings strongly suggest that development of a novel treatment strategy to control macroscopic or occult residual tumour is needed urgently to improve patient outcomes, especially for patients with residual tumour in the liver or those experiencing aggressive cancer progression after resection. No RCTs have demonstrated the efficacy of adjuvant or neoadjuvant therapy to improve outcomes after resection for HCC, with or without TT, and the outcomes were similar in patients with and those without preoperative treatment in the present study. However, preoperative and postoperative chemotherapy, including HAIC, could potentially be used to identify patients with aggressive tumour progression and to prevent recurrence after resection.…”

“…Little is known about TT of the IVC or RA owing to its rarity, and the therapeutic options and their indications, including resection, remain controversial 22 . The novel finding of this large case series, describing details of operative procedures, as well as short-and long-term patient outcomes, was that the OS of patients with residual tumours in the lung alone after resection was similar to that of patients who had resection with curative intent.…”

Diagnostik und Therapie des hepatozellulären Karzinoms

“…Die Einführung robotergestützter Resektionsverfahren ist in der Erprobung, deren Bedeutung aber bislang nicht absehbar. Limitierender Faktor operativer Eingriffe an der Leber ist demnach heute nicht mehr der technische Anspruch an eine den Kriterien der onkologischen Radikalität Rechnung tragende Chirurgie, sondern mehr die nach dem Eingriff verbleibende funktionelle Reserve der Restleber [7,8].…”

“…Ein orientierender Algorithmus der Behandlungsstrategien unter Berücksichtigung der Leitlinien-Empfehlungen ist in ▶Abb. 1 dargestellt[1][2][3][4][5][6][7].…”

Diagnostik und Therapie des hepatozellulären Karzinoms

“…Die inführung robotergestützter Resektionsverfahren ist in der rprobung, deren Bedeutung aber bislang nicht absehbar. Limitierender Faktor operativer ingri e an der Leber ist demnach heute nicht mehr der technische Anspruch an eine den Kriterien der onkologischen Radikalität Rechnung tragende Chirurgie, sondern mehr die nach dem ingri verbleibende funktionelle Reserve der Restleber [7,8].…”