The Role of Liver Resection for the Treatment of Hepatocellular Carcinoma
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.
KeywordsLiver cirrhosis Surgical resection Hepatocellular cancer
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