Surgical Treatment for Hepatocellular Carcinoma

Abstract

The treatment of hepatocellular carcinoma (HCC) has undergone evolution and refinement over the past three decades. Changes in the understanding of HCC with respect to tumor size, number and location, underlying liver function and portal pressure, and hepatic anatomy, in combination with refinement of surgical techniques and technologies, have greatly influenced the approach to surgical management. Surgery is considered the mainstay of curative HCC treatment with resection and transplantation achieving the best outcomes in well-selected candidates (5-year survival of 60–80 %). Surgical resection of HCC, especially within the Milano/Mazzaferro criteria (i.e., solitary tumor ≤ 5 cm or up to three tumors all ≤ 3 cm) in patients with well-preserved liver function (Child-Pugh A and selectively B patients), offers the greatest chances for survival. Liver transplantation is considered the treatment of choice for patients with compromised liver function (Child-Pugh B/C). The clinical parameters identified in this Chapter will be used to generate Digital Patient Models (DPMs) to facilitate diagnosis, prognosis, and treatment selection, i.e. Model Guided Therapy (MGT). The following have been identified as key issues relating to Predictive, Preventive, and Personalized Medicine (PPPM) and surgical treatment for HCC: tumor characterization, such as size, number, and vascular invasion; the patientʼs clinical status, particularly the presence of cirrhosis, the degree of portal hypertension, and liver functional reserve; pre-operative management, such as patient selection for resection or transplantation, choice of donor, down-staging and bridging therapies; and, surgical techniques, including techniques to minimize blood loss and to ensure an adequate liver remnant.