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The Role of Liver Resection for the Treatment of Hepatocellular Carcinoma

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Book cover Liver Cancers

Abstract

Choosing the best surgical treatment for a patient with liver cancer is rightly perceived as complex and confusing. Liver resection provides optimal outcomes for HCC in patients of good performance status with limited liver disease in the absence of portal hypertension. Liver resection is mostly complementary and not in competition with liver transplantation and could be used as a bridge especially with laparoscopic resections. Patient selection is crucial and should take place in a multidisciplinary care setting ideally with all treatment options including transplantation provided. EASL/AASLD guidelines can guide clinicians regarding management decisions; however, they are found too restrictive by clinicians, even in Western subgroups. Selected patients with portal hypertension, multifocal tumours (especially if not suitable for transplant) may benefit from resection as well as others with recurrent disease or macrovascular involvement. Where local expertise exists, the laparoscopic approach may lead to improved peri-operative outcomes. Recurrent disease should be treated aggressively, if possible, to optimise outcomes. These issues are clarified and discussed in this chapter along with some possible future advances.

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References

  1. Boleslawski E, Petrovai G, Truant S, Dharancy S, Duhamel A, Salleron J, et al. Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis. Br J Surg. 2012;99(6):855–63.

    Article  CAS  Google Scholar 

  2. Lam CM, Fan ST, Lo CM, Wong J. Major hepatectomy for hepatocellular carcinoma in patients with an unsatisfactory indocyanine green clearance test. Br J Surg. 1999;86:1012–46.

    Article  CAS  Google Scholar 

  3. Ogata S, Belghiti J, Farges O, Varma D, Sibert A, Vilgrain V. Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma. Br J Surg. 2006;93:1091–8.

    Article  CAS  Google Scholar 

  4. Huang J, Li BK, Chen GH, et al. Long-term outcomes and prognostic factors of elderly patients with hepatocellular carcinoma undergoing hepatectomy. J Gastrointest Surg. 2009;13(9):1627–35.

    Article  Google Scholar 

  5. Bruix J, Sherman M, American Association for the Study of Liver D. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2.

    Article  Google Scholar 

  6. European Association for the Study of the L, European Organisation for R, Treatment of C. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43.

    Article  Google Scholar 

  7. Kudo M, Matsui O, Izumi N, et al. JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the liver cancer study group of Japan. Liver Cancer. 2014;3(3-4):458–68.

    Article  Google Scholar 

  8. Guglielmi A, Ruzzenente A, Conci S, et al. Hepatocellular carcinoma: surgical perspectives beyond the Barcelona clinic liver cancer recommendations. World J Gastroenterol. 2014;20(24):7525–33.

    Article  Google Scholar 

  9. Berzigotti A, Reig M, Abraldes JG, Bosch J, Bruix J. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology. 2015;61(2):526–36.

    Article  Google Scholar 

  10. Torzilli G, Belghiti J, Kokudo N, et al. A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC east-west study group. Ann Surg. 2013;257(5):929–37.

    Article  Google Scholar 

  11. Tang YH, Wen TF, Chen X. Anatomic versus non-anatomic liver resection for hepatocellular carcinoma: a systematic review. Hepato-Gastroenterology. 2013;60(128):2019–25.

    PubMed  Google Scholar 

  12. Eguchi S, Kanematsu T, Arii S, Okazaki M, Okita K, Omata M, Ikai I, Kudo M, Kojiro M, Makuuchi M, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery. 2008;143:469–75.

    Article  Google Scholar 

  13. Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001;193(1):109–11.

    Article  CAS  Google Scholar 

  14. Liu CL, Fan ST, Cheung ST, Lo CM, Ng IO, Wong J. Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled study. Ann Surg. 2006;244(2):194–203.

    Article  Google Scholar 

  15. Moggia E, Rouse B, Simillis C, et al. Methods to decrease blood loss during liver resection: a network meta-analysis. Cochrane Database Syst Rev. 2016;10:CD010683.

    PubMed  Google Scholar 

  16. Morise Z, Ciria R, Cherqui D, Chen KH, Belli G, Wakabayashi G. Can we expand the indications for laparoscopic liver resection? A systematic review and meta-analysis of laparoscopic liver resection for patients with hepatocellular carcinoma and chronic liver disease. J Hepatobiliary Pancreat Sci. 2015;22(5):342–52.

    Article  Google Scholar 

  17. Twaij A, Pucher PH, Sodergren MH, Gall T, Darzi A, Jiao LR. Laparoscopic vs open approach to resection of hepatocellular carcinoma in patients with known cirrhosis: systematic review and meta-analysis. World J Gastroenterol. 2014;20(25):8274–81.

    Article  Google Scholar 

  18. Chen PD, Wu CY, Hu RH, et al. Robotic versus open hepatectomy for hepatocellular carcinoma: a matched comparison. Ann Surg Oncol. 2016;24(4):1021–8.

    Article  Google Scholar 

  19. D'Haese JG, Neumann J, Weniger M, et al. Should ALPPS be used for liver resection in intermediate-stage HCC? Ann Surg Oncol. 2016;23(4):1335–43.

    Article  CAS  Google Scholar 

  20. Zhang T, Zeng Y, Huang J, Liao M, Wu H. Combined resection with radiofrequency ablation for bilobar hepatocellular carcinoma: a single-center experience. J Surg Res. 2014;191(2):370–8.

    Article  Google Scholar 

  21. Pinsker N, Papoulas M, Sodergren M, Quaglia A, Suddle A, Jassem W, Melendez HV, Prachalias A, Srinivasan P, Menon K, Heaton N, et al. Outcomes following liver resection for ruptured and non-ruptured hepatocellular carcinoma–a propensity matched analysis. In: 19th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland. Wiley-Blackwell. 2016; p. 17, ISSN: 0007-1323.

    Google Scholar 

  22. Erridge S, Pucher PH, Markar SR, Malietzis G, Athanasiou T, Darzi A, et al. Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma. Br J Surg. 2017;104:1433–42.

    Article  CAS  Google Scholar 

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Correspondence to Dinesh Sharma .

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Sodergren, M.H., Sharma, D. (2019). The Role of Liver Resection for the Treatment of Hepatocellular Carcinoma. In: Cross, T., Palmer, D. (eds) Liver Cancers. Springer, Cham. https://doi.org/10.1007/978-3-319-92216-4_7

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  • DOI: https://doi.org/10.1007/978-3-319-92216-4_7

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