Review
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World J Gastroenterol. Nov 28, 2012; 18(44): 6398-6408
Published online Nov 28, 2012. doi: 10.3748/wjg.v18.i44.6398
Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients
Alessandro Cucchetti, Matteo Cescon, Franco Trevisani, Antonio Daniele Pinna
Alessandro Cucchetti, Matteo Cescon, Antonio Daniele Pinna, General Surgery and Transplant Unit, Department of General Surgery and Organ Transplantation, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
Franco Trevisani, Department of Clinical Medicine, Semeiotica Medica, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
Author contributions: Cucchetti A and Cescon M wrote the paper; Trevisani F provided critical expertise and reviewed the paper; Pinna AD provided critical expertise and helped with focusing the topics.
Correspondence to: Alessandro Cucchetti, MD, General Surgery and Transplant Unit, Department of General Surgery and Organ Transplantation, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. aleqko@libero.it
Telephone: +39-51-6363721 Fax: +39-51-304902
Received: April 17, 2012
Revised: July 23, 2012
Accepted: August 4, 2012
Published online: November 28, 2012
Abstract

Hepatocellular carcinoma (HCC) is one of the most frequent neoplasms worldwide and in most cases it is associated with liver cirrhosis. Liver resection is considered the most potentially curative therapy for HCC patients when liver transplantation is not an option or is not immediately accessible. This review is aimed at investigating the current concepts that drive the surgical choice in the treatment of HCC in cirrhotic patients; Eastern and Western perspectives are highlighted. An extensive literature review of the last two decades was performed, on topics covering various aspects of hepatic resection. Early post-operative and long-term outcome measures adopted were firstly analyzed in an attempt to define an optimal standardization useful for research comparison. The need to avoid the development of post-hepatectomy liver failure represents the “conditio sine qua non” of surgical choice and the role of the current tools available for the assessment of liver function reserve were investigated. Results of hepatic resection in relationship with tumor burden were compared with those of available competing strategies, namely, radiofrequency ablation for early stages, and trans-arterial chemoembolization for intermediate and advanced stages. Finally, the choice for anatomical versus non-anatomical, as well as the role of laparoscopic approach, was overviewed. The literature review suggests that partial hepatectomy for HCC should be considered in the context of multi-disciplinary evaluation of cirrhotic patients. Scientific research on HCC has moved, in recent years, from surgical therapy toward non-surgical approaches and most of the literature regarding topics debated in the present review is represented by observational studies, whereas very few well-designed randomized controlled trials are currently available; thus, no robust recommendations can be derived.

Keywords: Hepatocellular carcinoma; Hepatic resection; Surgical therapy; Ablation techniques; Transplantation; Survival; Liver failure