Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14381
Revised: May 25, 2014
Accepted: July 16, 2014
Published online: October 21, 2014
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. The treatment of HCC is complex and complicated by the severity of associated chronic liver disease, the stage of HCC, and the clinical condition of the patient. Liver resection (LR) is one of the most efficient treatments for patients with HCC, with an expected 5-year survival of 38%-61% depending on the stage of the disease. Improved liver function assessment, increased understanding of segmental liver anatomy from advanced imaging studies, and surgical technical progress are important factors that have led to reduced mortality in patients with HCC. The indication for LR may be expanded due to emerging evidences from laparoscopic hepatectomies and combined treatments with newly developed chemotherapies. Liver transplantation (LT) is considered as an ideal treatment for removal of existing tumors and the injured/preneoplastic underlying liver tissue with impaired liver function and the risk of multicentric carcinogenesis that results from chronically injured liver. However, LT is restricted to patients with minimal risk of tumor recurrence under immunosuppression. The expansion of criteria for LT in HCC patients is still under trial and discussion. Limited availability of grafts, as well as the risk and the cost of transplantation have led to considerable interest in expansion of the donor pool, living donor-related transplantation, and combined treatment involving LR and LT. This highlight presents evidence concerning recent studies evaluating LR and LT in HCC patients. In addition, alternative therapies for the treatment of early stage tumors and the management of patients on transplant waiting lists are discussed.
Core tip: Liver resection (LR) is one of the most efficient treatments for patients with hepatocellular carcinoma (HCC). Advances in assessment and treatment, including emerging evidence from laparoscopic hepatectomies and combined treatments with newly developed chemotherapies, may lead to expanded indications for LR. Liver transplantation (LT) is an ideal treatment for chronically injured liver tissue with impaired liver function and risk of multicentric carcinogenesis. The expansion of criteria for LT in HCC patients and combined treatment involving LR and LT are under trial and discussion. This highlight presents and discusses recent studies concerning LR and LT in HCC patients.