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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2015; 7(1): 70-77
Published online Jan 27, 2015. doi: 10.4254/wjh.v7.i1.70
Surgical approach for hepatitis C virus-related hepatocellular carcinoma
Junichi Shindoh, Masaji Hashimoto, Goro Watanabe
Junichi Shindoh, Masaji Hashimoto, Goro Watanabe, Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo 105-8470, Japan
Junichi Shindoh, Okinaka Memorial Research Center for Adult Diseases, Tokyo 105-8470, Japan
Author contributions: Shindoh J, Hashimoto M and Watanabe G contributed to this paper.
Supported by Grand-in-aid for Science Research from the Japanese Ministry of Education, Culture, Sports, Science and Technology, No. 26861063
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Junichi Shindoh, MD, PhD, Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan. shindou-tky@umin.ac.jp
Telephone: +81-3-35881111 Fax: +81-3-35881111
Received: August 19, 2014
Peer-review started: August 20, 2014
First decision: October 14, 2014
Revised: October 30, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: January 27, 2015
Processing time: 143 Days and 16.7 Hours
Abstract

Hepatitis C is a strong prognostic factor for patients with hepatocellular carcinoma (HCC). Although liver resection and liver transplantation offer the chance of a cure for HCC, adequate management of co-existing infection with hepatitis C virus (HCV) is important to enable better long-term outcomes after surgery for HCV-related HCC. For patients undergoing liver resection, perioperative anti-viral treatment is recommended, since a decreased HCV viral load itself is reportedly associated with a lower tumor recurrence rate and a longer overall survival. For patients undergoing transplanatations for HCC complicated by end-stage liver disease, the post-transplant management of HCV infection is also necessary to prevent progressive graft injury caused by active hepatitis under the immunosuppressive condition that is needed after liver transplantation. Although only a few lines of solid evidence are available for postoperative antiviral treatment because of the limited indication and frequent adverse events caused by conventional high-dose combination interferon therapy, new direct acting anti-viral agents would enable interferon-free anti-viral treatment with a higher virologic response and minimal side effects.

Keywords: Hepatocellular carcinoma; Hepatitis C; Liver resection; Liver transplantation; Adjuvant therapy

Core tip: Hepatitis C infection is associated with a poor survival outcome after curative surgical resection or liver transplantation in patients with hepatocellular carcinoma (HCC). For patients undergoing liver resection, the adequate perioperative management of hepatitis C is vital for reducing the carcinogenic potential of the liver remnant and obtaining a longer disease-free interval. For patients undergoing transplantations for HCC with end-stage liver disease, the control of hepatitis C is also needed to avoid progressive graft dysfunction because of active hepatitis under immunosuppressive condition.