Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Sep 17:3:64.
doi: 10.21037/tgh.2018.09.13. eCollection 2018.

Resection for hepatocellular cancer: overpassing old barriers

Francesco Giovanardi  1 , Quirino Lai  1 , Alessandra Bertacco  2 , Alessandro Vitale  2
Affiliations
Review

Resection for hepatocellular cancer: overpassing old barriers

Francesco Giovanardi et al. Transl Gastroenterol Hepatol. .

Abstract

Several recent studies have shown that the selection limits commonly used for patients with hepatocellular cancer (HCC) potentially requiring a liver resection (LR) are too restrictive. The present review aims at investigating the studies showing that LR is no longer a treatment suitable only for highly selected patients, but also for patients selectively presenting one-to-more negative factors. Several specific variables have been investigated, none of them showing to be an absolute contraindication for LR: age; single vs. multiple diseases; the dimension of the nodule; hyperbilirubinemia; clinically relevant portal hypertension; Child-Pugh status; macrovascular invasion. As a consequence, LR for the treatment of HCC-on-cirrhosis is a safe and effective procedure not only in "ideal cases", but also for selected patients presenting risk factors. The presence of only one of these factors does not represent an absolute contraindication for LR. On the opposite, the contemporaneous presence of risk factors should contraindicate the procedure. Further studies investigating the "borderline" cases are required, mainly looking at the possible decisive role of laparoscopy in this setting.

Keywords: Barcelona Clinic Liver Cancer (BCLC); Portal hypertension (PHT); liver failure; mini-invasive surgery; model for end-stage liver disease (MELD).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

    1. European Association for the Study of the Liver EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018;69:182-236. 10.1016/j.jhep.2018.03.019 - DOI - PubMed
    1. Bruix J, Sherman M, Llovet JM, et al. Clinical Management of Hepatocellular Carcinoma. Conclusions of the Barcelona-2000 EASL Conference. J Hepatol 2001;35:421-30. 10.1016/S0168-8278(01)00130-1 - DOI - PubMed
    1. European Association For The Study Of The Liver. European Organisation For Research And Treatment Of Cancer EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2012;56:908-43. 10.1016/j.jhep.2011.12.001 - DOI - PubMed
    1. Bolondi L, Cillo U, Colombo M, et al. Italian Association for the Study of the Liver (AISF). Position paper of the Italian Association for the Study of the Liver (AISF): The multidisciplinary clinical approach to hepatocellular carcinoma. Dig Liver Dis 2013;45:712-23. 10.1016/j.dld.2013.01.012 - DOI - PubMed
    1. Poon RT, Fan ST, Lo CM, et al. Hepatocellular carcinoma in the elderly: results of surgical and nonsurgical management. Am J Gastroenterol 1999;94:2460-6. 10.1111/j.1572-0241.1999.01376.x - DOI - PubMed