Current surgical treatment strategies for hepatocellular carcinoma in North America

Table 3 Overview of the common modalities used in the treatment of hepatocellular carcinoma

Treatment modality	Advantages	Disadvantages
Hepatic resection	Readily accessible	Not indicated for patients with advanced cirrhosis
	No waiting period	High recurrence rates (> 50% at 5 yr)
	5 yr survival of > 50% in carefully selected patients	Risk of post operative haptic failure
	Peri-operative mortality < 5%	Does not address risk of cancer in residual liver
	Not limited by tumor size
OLT	Low rate of recurrence in carefully selected patients	Restricted by size and number of lesions
	Post transplant survival rates similar to patients with OLT for all other causes	Risk of dropout while on wait list (38% drop out rate after 12 mo)
TACE/TAE	Indicated for treatment in patients not candidates for resection or OLT	Low curative potential when used alone with high recurrence rates
	Effective role as bridge for transplantation	Efficacy decreased for large sized tumors
	Established role in downstaging HCC to make patients OLT eligible	Does not address risk of cancer in residual liver
	Evidence of survival benefit after OLT when used as neo-adjuvant therapy in select patients
	Relatively low morbidity
RFA	Highly effective for HCC ≤ 3 cm	Decreased effectiveness in HCC ≥ 4 cm with high recurrence rates
	Effective bridge for OLT by decreasing drop out rate on wait list	May be limited by proximity of HCC to vascular pedicels
	Established role in downstaging HCC to make patients OLT eligible	Does not address risk of cancer in residual liver
	Relatively low morbidity and mortality

HCC: Hepatocellular carcinoma; OLT: Orthotopic liver transplantation; TACE: Transarterial chemoembolization; TAE: Transarterial embolization; RFA: Radiofrequency ablation.