Hepatocellular carcinoma: surgical indications and results

Effect of liver regeneration on malignant hepatic tumors

“…Liver regeneration after surgery provides a microenvironment with many growth factors and cytokines that are favorable for tumorgenesis and tumor propagation through cell activation, proliferation, migration and angiogenesis [16,19,[24][25][26][27] . The majority of studies in HCC indicate that factors linked to tumor invasiveness and vascular involvement are the most important [20] . In addition, the mechanisms involving endocrine, autocrine and paracrine occurring during liver regeneration can influence dormant micrometastases and tumorgenesis in the remnant liver [16,50] .…”

“…A relapse of malignant disease in the liver is a bad prognostic sign for the patient, and the therapeutic options might, depending on anatomical location, liver function and general performance status is limited. All the treatment modalities in use for primary treatment of liver tumors, i.e., surgical resection, liver transplantation, local ablation, and transcatheter arterial chemoembolization (TACE) http://en.wikipedia.org/wiki/Transcatheter_ar terial_chemoembolization have been tried in setting of recurrent disease [20,[100][101][102] . Repeat hepatectomy appears to be the best treatment with a reported resectability rate ranging from 10% to 77% [29] .…”

“…A longer interval from hepatectomy to recurrence is associated with improved survival [101,103] . TACE appears to be the best option in recurrent HCC tumors that are unresectable due to multimodularity or inadequate functional liver reserve [20] . TACE might in a few cases downstage the tumor size making it resectable [106] .…”

“…Modern surgical techniques and chemotherapy can improve the five-year survival rate for selected patients with CLM, but intrahepatic recurrence after liver resection occurs in 40%-60% of patients, usually within 12-18 mo postoperatively [18,19] . Although some patients may benefit from more aggressive approaches when recurrence is still observed in the liver, this is generally associated with a poor outcome in most of cases owing to multi-centricity or inadequate functional liver reserve if a resection were to be attempted [20][21][22][23] . The high frequency of tumor recurrence following liver surgery is still a significant clinical problem impairing the long-term survival.…”

Current management strategy of hepatocellular carcinoma

“…In selected patients, repeat resection provides good long-term benefits and is an option for those with solitary peripheral tumors that can be treated with segmental or atypical resection. In patients with adequate functional reserve capacity and no extrahepatic tumour growth, the 5-year survival rate after repeat resection has been reported to be as high as 86% [42] .…”