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Management of potentially resectable hepatocellular carcinoma: Prognosis, role of neoadjuvant and adjuvant therapy, and posttreatment surveillance

Steven A Curley, MD, FACS
Carlton C Barnett, Jr, MD
Eddie K Abdalla, MD
Amit G Singal, MD
Section Editor
Kenneth K Tanabe, MD
Deputy Editor
Diane MF Savarese, MD


Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease, which may be related to hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol, and/or nonalcoholic steatohepatitis (NASH), among other causes. (See "Epidemiology and etiologic associations of hepatocellular carcinoma".)

Potentially curative partial hepatectomy is one optimal treatment for HCC, but many patients are not eligible for resection because of extrahepatic disease spread, the anatomical constraints of the intrahepatic tumor, or poor underlying liver function, as reflected by the Child-Pugh classification (table 1) or the Model for End-stage Liver Disease (MELD) score (calculator 1 and calculator 2). (See "Assessing surgical risk in patients with liver disease", section on 'MELD score' and "Model for End-stage Liver Disease (MELD)".)

Even after a potentially curative resection, local recurrence rates are high. This has led to efforts to develop neoadjuvant and adjuvant systemic therapy approaches to improve outcomes, although these have unfortunately been unsuccessful at reducing recurrence or improving survival to date.

This topic will cover prognosis and neoadjuvant and adjuvant therapy for potentially resectable hepatocellular cancer, as well as posttreatment surveillance. The clinical manifestations and diagnosis of HCC, preoperative evaluation and surgical management, nonsurgical options for local ablation, role of liver transplantation, treatment of advanced disease, and an overview of treatment approaches to HCC are presented separately.

(See "Epidemiology and etiologic associations of hepatocellular carcinoma".)

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Literature review current through: Nov 2017. | This topic last updated: Mar 16, 2017.
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