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World J Hepatol. May 18, 2016; 8(14): 607-615
Published online May 18, 2016. doi: 10.4254/wjh.v8.i14.607
Liver resection for intermediate hepatocellular carcinoma
Peng-Sheng Yi, Ming Zhang, Ji-Tong Zhao, Ming-Qing Xu
Peng-Sheng Yi, Ming Zhang, Ming-Qing Xu, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Ji-Tong Zhao, Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Yi PS drafted the article; Zhang M designed the study; Zhao JT analyzed and interpreted the data; Xu MQ approved the final version to be submitted; Yi PS and Zhang M contributed equally to this work.
Conflict-of-interest statement: No conflict of interests is declared by the authors.
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: Ming-Qing Xu, MD, Department of Liver Surgery, West China Hospital, Sichuan University, Guoxue Road, Chengdu 610041, Sichuan Province, China. xumingqing0018@163.com
Telephone: +86-28-85422870 Fax: +86-28-85422870
Received: January 22, 2016
Peer-review started: January 22, 2016
First decision: March 1, 2016
Revised: March 14, 2016
Accepted: April 21, 2016
Article in press: April 22, 2016
Published online: May 18, 2016
Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. The Barcelona Clinic Liver Cancer (BCLC) staging system is regarded as the gold standard staging system for HCC, classifying HCC as early, intermediate, or advanced. For intermediate HCC, trans-catheter arterial chemoembolization (TACE) is recommended as the optimal strategy by the BCLC guideline. This review investigates whether liver resection is better than TACE for intermediate HCC. Based on published studies, we compare the survival benefits and complications of liver resection and TACE for intermediate HCC. We also compare the survival benefits of liver resection in early and intermediate HCC. We find that liver resection can achieve better or at least comparable survival outcomes compared with TACE for intermediate HCC; however, we do not observe a significant difference between liver resection and TACE in terms of safety and morbidity. We conclude that liver resection may improve the short- and long-term survival of carefully selected intermediate HCC patients, and the procedure may be safely performed in the management of intermediate HCC.

Keywords: Trans-catheter arterial chemoembolization, Intermediate hepatocellular carcinoma, Liver resection, Prognostic factor

Core tip: Trans-catheter arterial chemoembolization (TACE) is recommended as the standard treatment of intermediate hepatocellular carcinoma (HCC) by the Barcelona Clinic Liver Cancer guideline, and this review investigates whether liver resection is better than TACE for intermediate HCC. Based on published studies, we compare the survival benefits and complications of liver resection and TACE for intermediate HCC. We also compare the survival benefits of liver resection in early and intermediate HCC. We find that liver resection could achieve better or at least comparable survival outcomes compared with TACE for intermediate HCC; however, we do not observe a significant difference between liver resection and TACE in terms of safety and morbidity.