Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2014; 6(12): 836-843
Published online Dec 27, 2014. doi: 10.4254/wjh.v6.i12.836
Role of hepatectomy for recurrent or initially unresectable hepatocellular carcinoma
Yoji Kishi, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Tomoo Kosuge
Yoji Kishi, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Tomoo Kosuge, Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Author contributions: All the authors contributed to the work.
Supported by Grant-in-aid from the 106th Annual Congress of the JSS Memorial Surgical Research Fund, Tokyo, Japan
Correspondence to: Yoji Kishi, MD, PhD, Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. yokishi@ncc.go.jp
Telephone: +81-33-5422511 Fax: +81-33-5423815
Received: July 31, 2014
Revised: September 30, 2014
Accepted: October 28, 2014
Published online: December 27, 2014
Abstract

As a result of donor shortage and high postoperative morbidity and mortality after liver transplantation, hepatectomy is the most widely applicable and reliable option for curative treatment of hepatocellular carcinoma (HCC). Because intrahepatic tumor recurrence is frequent after loco-regional therapy, repeated treatments are advocated provided background liver function is maintained. Among treatments including local ablation and transarterial chemoembolization, hepatectomy provides the best long-term outcomes, but studies comparing hepatectomy with other nonsurgical treatments require careful review for selection bias. In patients with initially unresectable HCC, transarterial chemo-or radio-embolization, and/or systemic chemotherapy can down-stage the tumor and conversion to resectable HCC is achieved in approximately 20% of patients. However, complete response is rare, and salvage hepatectomy is essential to help prolong patients’ survival. To counter the short recurrence-free survival, excellent overall survival is obtained by combining and repeating different treatments. It is important to recognize hepatectomy as a complement, rather than a contraindication, to other nonsurgical treatments in a multidisciplinary approach for patients with HCC, including recurrent or unresectable tumors.

Keywords: Hepatocellular carcinoma, Hepatectomy, Repeat hepatectomy, Conversion therapy, Multidisciplinary treatment

Core tip: Previous studies comparing hepatectomy with other nonsurgical treatments for hepatocellular carcinoma (HCC) evaluated which provided superior survival benefit. However, considering the high recurrence rate after curative loco-regional treatment, and limited indications for hepatectomy because of background liver damage, it is important to recognize hepatectomy as a complement to other nonsurgical treatment, rather than a contraindication. A multidisciplinary approach combining and repeating different treatments prolongs patients’ survival with HCC, including those with recurrent or initially unresectable tumors.