The Liver and Metastatic Cancer Resourse Site
Liver resection as primary treatment for hepatocellular cancer
Hepatocellular carcinoma or hepatocellular cancer (HCC) is the most common primary cancer of the liver. It is the fifth most common cancer throughout the world. However, only about twenty percent of patients will be treated with chance for cure. This opportunity for cure exists only within the separate treatment modalities of liver resection and liver transplantation. Many of the patients who are candidates for liver transplantation are also candidates for liver resection. If a solitary HCC is less than five cm and has no invasion of the major hepatic or portal veins or if the patient has three or less HCC’s with no invasion into the veins, then the patient is a candidate for transplantation. If the patient has good liver function, then he or she is also a candidate for liver resection. When to transplant and when to resect in this group of patients is controversial in the liver surgery community. The following abstract by Jacques Belghiti presents the case for liver resection as the first choice and transplantation as its backup. The case for liver transplantation is made elsewhere on this website.
Abstract by Belghiti, et al follows.
Langenbecks Arch Surg. 2012 Jan 31. [Epub ahead of print]
HCC: current surgical treatment concepts.
Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy, France, University Denis Diderot-Paris 7, Paris, France.
PURPOSE: The purpose of this study is to review indications and results of surgical treatments of hepatocellular carcinoma (HCC). This tumor, which represents one of the most common malignancies worldwide, is characterized by its prominent development in patients with chronic liver disease (CLD). Liver transplantation (LT) is considered as the ideal treatment of limited HCC removing both tumor(s) and the pre-neoplasic underlying diseased liver. However, this treatment, which is not available in many countries, is restricted to patients with minimum risk of tumor recurrence under immunosuppression. The risk of recurrence is minimized in patients fulfilling the Milan criteria with a tendency to accept slight expansion of size in patients with favourable natural history and low AFP level. Increasing duration in the waiting list before LT leads several teams to use neoadjuvant therapies such as percutaneous ablation, TACE and liver resection. Liver resection in cirrhotic patients with good liver function remains the most available efficient treatment of patients with HCC. Better liver function assessment, understanding of the segmental liver anatomy with more accurate imaging studies and surgical technique refinements are the most important factors that have contributed to reduce mortality with an expecting 5 years survival of 70%. There is considerable interest in combined treatment associating resection and LT. Transplantable patients with good liver function should be considered for liver resection as primary therapy and for LT in case of tumor recurrence. This salvage strategy is refined using pathological analysis of the resected specimen which identifies histological pejorative factors allowing selecting patients who should transplanted before recurrence. CONCLUSIONS: The improvement of survival in HCC patients after surgical treatment results from refinements in surgical technique and better identification of adverse prognostic factors.
[PubMed - as supplied by publisher]