Asia-Pacific modified Delphi consensus conference on large hepatocellular carcinoma

Abstract

Background: Approximately 80 % of primary liver cancer cases happen in Asia-Pacific and become the leading cause of cancer-related mortality. However, there is no consensus on defining and standardizing the optimal management of large HCCs.

Methods: The Asia-Pacific Consensus Conference employed the Modified Delphi method, consisting of three rounds of surveys followed by a discussion panel. In this process, 31 experts anonymously contributed their opinions to refine statements and achieve a consensus on large HCC.

Results: A large hepatocellular carcinoma (HCC) is a nodule measuring ≥5 cm. A distinct BCLC staging system is recommended for solitary large HCC (SLHCC) without vascular invasion or tumor dissemination, as these cases show prolonged survival and lower recurrence rates post-liver resection. Portal vein tumor thrombosis (PVTT) is a crucial prognostic factor. Diagnosis of SLHCC can rely on multiphasic contrast-enhancing radiology (CT/MRI) and AFP levels ≥400. Preoperative liver function assessments guide resection planning where liver volumetry is unavailable. Major hepatectomy and laparoscopic approaches are viable for SLHCC, and postoperative radiological surveillance is essential.

Conclusion: Tailoring surgical approaches, ensuring readiness, and optimizing resources are key to successful single large HCC management. This consensus aims to guide surgeons, especially in the Asia-Pacific region.