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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): 93-100
Published online Jan 27, 2015. doi: 10.4254/wjh.v7.i1.93
From minimal to maximal surgery in the treatment of hepatocarcinoma: A review
Marcos Vinicius Perini, Graham Starkey, Michael A Fink, Ramesh Bhandari, Vijayaragavan Muralidharan, Robert Jones, Christopher Christophi
Marcos Vinicius Perini, Graham Starkey, Michael A Fink, Ramesh Bhandari, Vijayaragavan Muralidharan, Robert Jones, Christopher Christophi, Austin Health, Department of Surgery, University of Melbourne, Heidelberg, VIC 3084, Australia
Author contributions: Perini MV designed the review, collected data, wrote the manuscript; Starkey G reviewed the manuscript; Fink MA, Bhandari R, Muralidharan V, Jones R and Christophi C reviewed the manuscript.
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: Marcos Vinicius Perini, MD, PhD, Austin Health, Department of Surgery, University of Melbourne, 145 Studley Road, Level 8, Heidelberg, VIC 3084, Australia. marcos.perini@unimelb.edu.au
Telephone: +61-422-493101 Fax: +61-394-963670
Received: September 11, 2014
Peer-review started: September 13, 2014
First decision: October 14, 2014
Revised: October 28, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: January 27, 2015
Abstract

Hepatocellular carcinoma represents one of the most challenging frontiers in liver surgery. Surgeons have to face a broad spectrum of aspects, from the underlying liver disease to the new surgical techniques. Safe liver resection can be performed in patients with portal hypertension and well-compensated liver function with a 5-year survival rate of 50%, offering good long-terms results in selected patients. With the advances in laparoscopic surgery, major liver resections can be performed with minimal harm, avoiding the wound and leak complications related to the laparotomies. Studies have shown that oncological margins are the same as in open surgery. In patients submitted to liver resection (either laparoscopic or open) who experience recurrence, re-resection or salvage liver transplantation has been showing to be an alternative approach in well selected cases. The decision making approach to the cirrhotic patient is becoming more complex and should involve hepatologists, liver surgeons, radiologists and oncologists. Better understanding of the different risk factors for recurrence and survival should be aimed in these multidisciplinary discussions. We here in discuss the hot topics related to surgical risk factors regarding the surgical treatment of hepatocellular carcinoma: anatomical resection, margin status, macrovascular tumor invasion, the place of laparoscopy, salvage liver transplantation and liver transplantation.

Keywords: Hepatectomy, Liver resection, Cirrhosis, Liver transplantation, Hepatocellular carcinoma, Survival

Core tip: The decision making approach to the cirrhotic patient with hepatocellular carcinoma (HCC) represents one of the most challenging frontiers in liver surgery and, as a result, should involve a multidisciplinary assessment. Despite the advances in non-surgical therapies, surgery is still the treatment that can offer the best survival. In patients submitted to liver resection who experience recurrence, re-resection or salvage liver transplantation has been shown to be an alternative approach in well-selected cases. We herein discuss some controversial topics regarding the surgical treatment of HCC: anatomical resection, margin status, macro-vascular invasion, laparoscopic resection, salvage liver transplantation and liver transplantation.