Surgical management of hepatoma

Abstract

Hepatocellular carcinoma (HCC) remains one of the world’s most common deadly cancers. During the past several years progress in the treatment of this malignancy has been slow despite numerous advances in imaging, resection techniques, transplantation, perioperative care, and palliative options. Unfortunately, most patients who present with HCC are unresectable at the time of their diagnosis and are therefore not curable. For these patients a variety of palliative treatment modalities exist, some of which are effective in enhancing the quality of life and prolonging survival. For the potentially resectable patient, a number of factors must be considered before resection is performed. Determining resectability in patients with HCC can be difficult. They represent a more challenging group than some other patients with liver tumors, such as those with colorectal hepatic metastases, in that many HCC patients with resectable tumors carry the added burden of cirrhosis and/or chronic hepatitis. This adds the another dimension to the preoperative workup, which determines whether a technically resectable patient will have sufficient hepatic reserve to survive the postoperative stress of hepatic resection. The majority of operative mortality from liver resection for HCC is caused by hepatic failure. In this chapter we focus upon the current staging workup for the potentially resectable patient, operative decisionmaking and techniques, and the factors dictating prognosis for the resected patient.