Multidisciplinary Team Management of Hepatocellular Carcinoma in the MENA Region: Current Practices, Challenges, and Gaps

Mohamed El-Kassas^{1

2}, Rofida Khalifa³, Khalid M AlNaamani^{2

4}, Hend Shousha⁵, Yusuf Yilmaz^{2

6}, Faisal M Sanai^{2

7}, Maen Almattooq^{2

8}, Asma Labidi^{2

9}, Maisam W I Akroush^{2

10}, Nabil Debzi^{2

11}, Mohamed Omar Abdelmalek¹², Nermeen Sherif Abdeen¹³, Ali Tumi^{2

14}, Mohamed Elbadry^{1

2}, Amr El Fouly¹, Eman Marwan¹, Jassim Al Suwaidi¹⁵, Abdel-Naser Elzouki^{2

16}, Khalid A Alswat^{2

17}; Steatotic Liver Disease Study Foundation in Middle East and North Africa (SLMENA) Collaborators

Collaborators, Affiliations

Collaborators

Steatotic Liver Disease Study Foundation in Middle East and North Africa (SLMENA) Collaborators:
Chikhi Yazid¹⁸, Saidani Khadidja¹⁹, Sherif Ahmed²⁰, Hanaa Fathelbab²¹, Mohamed Kohla²², Eman Barakat²³, Wessam Abdellatif²⁴, Mina Tharwat²⁵, Asmaa Mohammad²⁶, Sawsan Abd El-Moniem²⁷, Asem Elfert²⁸, Yasmeen Ahmed²³, Mohammed Ahmed²⁹, Usama Eldaly³⁰, Essam Hassan³¹, Fawzi Abdel-Rahman³², Munira Altarrah³³, Dalal Alhaqqan³⁴, Elhusain Kamoka³⁵, Mustapha Benazzouz³⁶, Rashid ALSukaiti³⁷, Itrat Mehdi³⁸, Asim Jamal Shaikh³⁹, Al Warith Al Hashmi⁴⁰, Kakil Rasul⁴¹, Kanan Alshammari⁴², Khalid Bzeizi⁴³, Adnan Alzanbagi⁴⁴, Haythem Yacoub⁴⁵, Amal Khsiba⁴⁶, Nour Elleuch⁴⁷, Ilker Turan⁴⁸, Murat Kiyici⁴⁹, Levent Doganay⁵⁰, Gökhan Kabaçam⁵¹, Umit Karaogullarindan⁵², Coskun Demirtas⁵³, Cem Simsek⁵⁴, Sezai Yilmaz⁵⁵, Murat Akyildiz⁵⁶, Dilara Turan Gökçe⁵⁷, Murat Dayangac⁵⁸, Murat Gülşen⁵⁹, Yasar Tuna⁶⁰, Sencan Acar⁶¹, Derya Ari⁶²

Affiliations

¹ Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
² Steatotic Liver Diseases Study Foundation in Middle East and North Africa (SLMENA), Cairo, Egypt.
³ Tropical Medicine Department, Faculty of Medicine, Minia University, Minya, Egypt.
⁴ Department of Medicine, Division of Gastroenterology and Hepatology, The Medical City for Military and Security Services, Muscat, Oman.
⁵ Endemic Medicine and Hepato-Gastroenterology Department, Cairo University, Cairo, Egypt.
⁶ Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
⁷ Gastroenterology Section, Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia.
⁸ Gastroenterology and Hepatology Department, Jaber AlAhmad Hospital, Kuwait City, Kuwait.
⁹ Department of Gastroenterology "A", Rabta Hospital, Tunis, Tunisia.
¹⁰ Digestive and Liver Disease Clinic, Private Sector, Faculty of Medicine, Jordan University, Amman, Jordan.
¹¹ Hepatology Department, Mustapha Bacha University Hospital, Algiers, Algeria.
¹² Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt.
¹³ Tropical Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
¹⁴ Medical Department, Central Hospital, Tripoli, Libya.
¹⁵ Scientific, Academic, and Faculty Affairs, Hamad Medical Corporation, Doha, Qatar.
¹⁶ Department of Medicine, Hamad Medical Corporation and College of Medicine, Qatar University, Doha, Qatar.
¹⁷ Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹⁸ Interne Medicine Department, EPH Tipaza, Tipaza, Algeria.
¹⁹ Faculty of Medicine, Algiers, Algeria.
²⁰ Hepatology and Gastroenterology Department, Faculty of Medicine, Zagazig University, Egypt.
²¹ Tropical Medicine Department, Minia University, ElMinya, Egypt.
²² Hepatology and Gastroenterology Department, National Liver Institute, Shebeen El-Kom, Egypt.
²³ Tropical Medicine Department, Ain-Shams University, Cairo, Egypt.
²⁴ Radiology Department, National Hepatology & Tropical Medicine Research Institute, Cairo, Egypt.
²⁵ Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Aswan University, Aswan, Egypt.
²⁶ Tropical Medicine and Gastroenterology Department, Sohag University, Egypt.
²⁷ Hepatology and Gastroenterology Unit, Mansoura, Egypt.
²⁸ Tropical Medicine Department, Tanta University, Egypt.
²⁹ Hepatology, Gastroenterology and Infectious Disease Department, Kafr Elsheikh, Egypt.
³⁰ Medical oncology Department, Damietta oncology Center, Egypt.
³¹ Endemic Medicine Department, Fayoum University, Fayoum, Egypt.
³² Private Sector, Amman, Jordan.
³³ Gastroenterology and Hepatology Department, Al Amiri Hospital, Kuwait City, Kuwait.
³⁴ Department of Gastroenterology, Mubarak AlKabeer Hospital, AlJabriya, Kuwait.
³⁵ Surgical Oncology Department, National Cancer Institute, Sabratha, Libya.
³⁶ Hepatology and Gastroenterology Department, Rabat International University, Rabat, Morrocco.
³⁷ Radiology and Nuclear Medicine, University Medical City, Muscat, Oman.
³⁸ Medical Oncology Department, The Royal Hospital, Muscat, Oman.
³⁹ Medical Oncology Department, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
⁴⁰ Hepatobiliary and liver Transplant Surgery, Royal Hospital, Muscat, Oman.
⁴¹ Medical Oncology, NCCCR, Doha, Qatar.
⁴² Department of Oncology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
⁴³ Liver & Small Bowel Health Centre, King Faisal Specialist Hospital & Research Center Riyadh, Saudi Arabia.
⁴⁴ Gastroenterology Department, King Abdullah Medical City, Makkah, Saudi Arabia.
⁴⁵ Gastroenterology B Department, La Rabta Hospital, Tunis, Tunisie.
⁴⁶ Gastroenterology Department, Tunis El Manar University, Mohamed Tahar Maamouri Hospital Nabeul, Tunisia.
⁴⁷ Department of Gastroenterology, University of Sousse, Sousse, Tunisia.
⁴⁸ Gastroenterology Department, Ege University School of Medicine, Izmir, Turkey.
⁴⁹ Gastroenterology Department, Uludag University, Bursa, Turkey.
⁵⁰ Gastroenterology and Hepatology Department, Bau Medical School Pendik Medicalpar Hospital, İstanbul, Turkey.
⁵¹ Liver Transplantation Department, Guven Hospital, Ankara, Turkey.
⁵² Gastroenterology Department, Cukurova University, Adana, Turkey.
⁵³ Gastroenterology and Hepatology Department, Marmara University School of Medicine, Istanbul, Türkiye.
⁵⁴ Gastroenterology Department, Hacettepe, Ankara, Turkey.
⁵⁵ Liver Transplantation Institute, Inonu University, Malatya, Türkiye.
⁵⁶ Gastroenterology and Liver Transplantation, Koc University Hospital, Istanbul, Turkey.
⁵⁷ Gastroenterology Bilkent City Hospital, Ankara, Türkiye.
⁵⁸ Department of Hepatobiliary Surgery and Liver Transplantation Istanbul Medipol University, Istanbul, Türkiye.
⁵⁹ Gastroenterology Department, Gaziantep University, Gaziantep, Türkiye.
⁶⁰ Antalya Medicalpark Gastroenteroloji, Medicalpark Antalya, Antalya, Turkey.
⁶¹ Gastroenterology Department, Istanbul Florence Nightingale Hospital, Istanbul, Türkiye.
⁶² Gastroenterology Department, Ankara Bilkent City Hospital, Ankara, Turkey.

PMID: 40661239
PMCID: PMC12256939
DOI: 10.2147/JHC.S528470

Multidisciplinary Team Management of Hepatocellular Carcinoma in the MENA Region: Current Practices, Challenges, and Gaps

Mohamed El-Kassas et al. J Hepatocell Carcinoma. 2025.

. 2025 Jul 8:12:1315-1335.

doi: 10.2147/JHC.S528470. eCollection 2025.

Authors

Collaborators

Steatotic Liver Disease Study Foundation in Middle East and North Africa (SLMENA) Collaborators:
Chikhi Yazid¹⁸, Saidani Khadidja¹⁹, Sherif Ahmed²⁰, Hanaa Fathelbab²¹, Mohamed Kohla²², Eman Barakat²³, Wessam Abdellatif²⁴, Mina Tharwat²⁵, Asmaa Mohammad²⁶, Sawsan Abd El-Moniem²⁷, Asem Elfert²⁸, Yasmeen Ahmed²³, Mohammed Ahmed²⁹, Usama Eldaly³⁰, Essam Hassan³¹, Fawzi Abdel-Rahman³², Munira Altarrah³³, Dalal Alhaqqan³⁴, Elhusain Kamoka³⁵, Mustapha Benazzouz³⁶, Rashid ALSukaiti³⁷, Itrat Mehdi³⁸, Asim Jamal Shaikh³⁹, Al Warith Al Hashmi⁴⁰, Kakil Rasul⁴¹, Kanan Alshammari⁴², Khalid Bzeizi⁴³, Adnan Alzanbagi⁴⁴, Haythem Yacoub⁴⁵, Amal Khsiba⁴⁶, Nour Elleuch⁴⁷, Ilker Turan⁴⁸, Murat Kiyici⁴⁹, Levent Doganay⁵⁰, Gökhan Kabaçam⁵¹, Umit Karaogullarindan⁵², Coskun Demirtas⁵³, Cem Simsek⁵⁴, Sezai Yilmaz⁵⁵, Murat Akyildiz⁵⁶, Dilara Turan Gökçe⁵⁷, Murat Dayangac⁵⁸, Murat Gülşen⁵⁹, Yasar Tuna⁶⁰, Sencan Acar⁶¹, Derya Ari⁶²

Affiliations

¹ Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
² Steatotic Liver Diseases Study Foundation in Middle East and North Africa (SLMENA), Cairo, Egypt.
³ Tropical Medicine Department, Faculty of Medicine, Minia University, Minya, Egypt.
⁴ Department of Medicine, Division of Gastroenterology and Hepatology, The Medical City for Military and Security Services, Muscat, Oman.
⁵ Endemic Medicine and Hepato-Gastroenterology Department, Cairo University, Cairo, Egypt.
⁶ Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
⁷ Gastroenterology Section, Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia.
⁸ Gastroenterology and Hepatology Department, Jaber AlAhmad Hospital, Kuwait City, Kuwait.
⁹ Department of Gastroenterology "A", Rabta Hospital, Tunis, Tunisia.
¹⁰ Digestive and Liver Disease Clinic, Private Sector, Faculty of Medicine, Jordan University, Amman, Jordan.
¹¹ Hepatology Department, Mustapha Bacha University Hospital, Algiers, Algeria.
¹² Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt.
¹³ Tropical Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
¹⁴ Medical Department, Central Hospital, Tripoli, Libya.
¹⁵ Scientific, Academic, and Faculty Affairs, Hamad Medical Corporation, Doha, Qatar.
¹⁶ Department of Medicine, Hamad Medical Corporation and College of Medicine, Qatar University, Doha, Qatar.
¹⁷ Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹⁸ Interne Medicine Department, EPH Tipaza, Tipaza, Algeria.
¹⁹ Faculty of Medicine, Algiers, Algeria.
²⁰ Hepatology and Gastroenterology Department, Faculty of Medicine, Zagazig University, Egypt.
²¹ Tropical Medicine Department, Minia University, ElMinya, Egypt.
²² Hepatology and Gastroenterology Department, National Liver Institute, Shebeen El-Kom, Egypt.
²³ Tropical Medicine Department, Ain-Shams University, Cairo, Egypt.
²⁴ Radiology Department, National Hepatology & Tropical Medicine Research Institute, Cairo, Egypt.
²⁵ Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Aswan University, Aswan, Egypt.
²⁶ Tropical Medicine and Gastroenterology Department, Sohag University, Egypt.
²⁷ Hepatology and Gastroenterology Unit, Mansoura, Egypt.
²⁸ Tropical Medicine Department, Tanta University, Egypt.
²⁹ Hepatology, Gastroenterology and Infectious Disease Department, Kafr Elsheikh, Egypt.
³⁰ Medical oncology Department, Damietta oncology Center, Egypt.
³¹ Endemic Medicine Department, Fayoum University, Fayoum, Egypt.
³² Private Sector, Amman, Jordan.
³³ Gastroenterology and Hepatology Department, Al Amiri Hospital, Kuwait City, Kuwait.
³⁴ Department of Gastroenterology, Mubarak AlKabeer Hospital, AlJabriya, Kuwait.
³⁵ Surgical Oncology Department, National Cancer Institute, Sabratha, Libya.
³⁶ Hepatology and Gastroenterology Department, Rabat International University, Rabat, Morrocco.
³⁷ Radiology and Nuclear Medicine, University Medical City, Muscat, Oman.
³⁸ Medical Oncology Department, The Royal Hospital, Muscat, Oman.
³⁹ Medical Oncology Department, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
⁴⁰ Hepatobiliary and liver Transplant Surgery, Royal Hospital, Muscat, Oman.
⁴¹ Medical Oncology, NCCCR, Doha, Qatar.
⁴² Department of Oncology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
⁴³ Liver & Small Bowel Health Centre, King Faisal Specialist Hospital & Research Center Riyadh, Saudi Arabia.
⁴⁴ Gastroenterology Department, King Abdullah Medical City, Makkah, Saudi Arabia.
⁴⁵ Gastroenterology B Department, La Rabta Hospital, Tunis, Tunisie.
⁴⁶ Gastroenterology Department, Tunis El Manar University, Mohamed Tahar Maamouri Hospital Nabeul, Tunisia.
⁴⁷ Department of Gastroenterology, University of Sousse, Sousse, Tunisia.
⁴⁸ Gastroenterology Department, Ege University School of Medicine, Izmir, Turkey.
⁴⁹ Gastroenterology Department, Uludag University, Bursa, Turkey.
⁵⁰ Gastroenterology and Hepatology Department, Bau Medical School Pendik Medicalpar Hospital, İstanbul, Turkey.
⁵¹ Liver Transplantation Department, Guven Hospital, Ankara, Turkey.
⁵² Gastroenterology Department, Cukurova University, Adana, Turkey.
⁵³ Gastroenterology and Hepatology Department, Marmara University School of Medicine, Istanbul, Türkiye.
⁵⁴ Gastroenterology Department, Hacettepe, Ankara, Turkey.
⁵⁵ Liver Transplantation Institute, Inonu University, Malatya, Türkiye.
⁵⁶ Gastroenterology and Liver Transplantation, Koc University Hospital, Istanbul, Turkey.
⁵⁷ Gastroenterology Bilkent City Hospital, Ankara, Türkiye.
⁵⁸ Department of Hepatobiliary Surgery and Liver Transplantation Istanbul Medipol University, Istanbul, Türkiye.
⁵⁹ Gastroenterology Department, Gaziantep University, Gaziantep, Türkiye.
⁶⁰ Antalya Medicalpark Gastroenteroloji, Medicalpark Antalya, Antalya, Turkey.
⁶¹ Gastroenterology Department, Istanbul Florence Nightingale Hospital, Istanbul, Türkiye.
⁶² Gastroenterology Department, Ankara Bilkent City Hospital, Ankara, Turkey.

PMID: 40661239
PMCID: PMC12256939
DOI: 10.2147/JHC.S528470

Abstract

Purpose: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with a high disease burden in the Middle East and North Africa (MENA) region. Multidisciplinary teams (MDTs) are essential for optimizing HCC management; however, their implementation and impact may vary across healthcare settings. This study evaluates the structure, decision-making processes, and challenges faced by MDTs in HCC treatment centers across the MENA region.

Patients and methods: This cross-sectional, multicenter study surveyed representatives from 53 HCC treatment centers across 38 cities in 11 MENA countries. A structured questionnaire was electronically distributed to assess MDT composition, meeting frequency, decision-making processes, adherence to clinical guidelines, patient management pathways, and challenges in HCC treatment.

Results: Among the surveyed centers, 84.9% (n=45) reported having an established MDT. The most common specialties involved in MDT composition were hepatology (100%), interventional radiology (97.8%), medical oncology (91.1%), and hepatobiliary surgery (80%). Barcelona Clinic Liver Cancer staging was used in 95.6% of centers. Despite acknowledging MDT benefits, major challenges were documented by participants, including resource limitations (13.2%), financial constraints (13.2%), patient nonadherence (9.4%), and limited access to advanced technology (11.3%). Telemedicine was underutilized (9.4% of centers), and only 15.1% experienced participation in clinical trials.

Conclusion: Our result highlights the pivotal role of MDTs in HCC management in the MENA region, demonstrating adherence to evidence-based guidelines and exposing critical gaps in resource availability, technology integration, and patient-centered decision-making. Strengthening MDTs through enhanced resource allocation, digital health adoption, and increased clinical trial participation is essential to improving HCC outcomes in the region.

Keywords: MENA region; cancer management; clinical decision-making; hepatocellular carcinoma; multidisciplinary team.

Plain language summary

This study identifies critical gaps in multidisciplinary hepatocellular carcinoma (HCC) management across the Middle East and North Africa (MENA). Despite recognizing multidisciplinary teams’ value, inconsistent implementation, fragmented referral pathways, limited diagnostic tool accessibility, and insufficient public awareness significantly hinder optimal patient care. Addressing these gaps urgently requires integrated national policies, expanded diagnostic infrastructure, enhanced clinician training, structured referral systems, and stronger public and patient engagement strategies. The study underscores the necessity for a strategic, coordinated approach to improve clinical outcomes and reduce the healthcare burden of HCC in the region.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

**Figure 1**
Strategies to improve the MDT processes at the HCC treatment centers in the MENA region.

See this image and copyright information in PMC

References

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Multidisciplinary Team Management of Hepatocellular Carcinoma in the MENA Region: Current Practices, Challenges, and Gaps

Collaborators

Affiliations

Multidisciplinary Team Management of Hepatocellular Carcinoma in the MENA Region: Current Practices, Challenges, and Gaps

Authors

Collaborators

Affiliations

Abstract

Plain language summary

Conflict of interest statement

Figures

References