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Surgical management of potentially resectable hepatocellular carcinoma

Authors
Steven A Curley, MD, FACS
Carlton C Barnett, Jr, MD
Eddie K Abdalla, MD
Section Editors
Stanley W Ashley, MD
Kenneth K Tanabe, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Hepatocellular carcinoma (HCC) is a tumor with highly variable biology that often occurs in the setting of chronic liver disease and cirrhosis. It is typically diagnosed late in its course, and the median survival following diagnosis is approximately 6 to 20 months [1]. The mainstay of potentially curative treatment for hepatocellular carcinoma is surgical resection, but several other treatment modalities may also have a role. In properly selected and prepared patients, hepatectomy for hepatocellular carcinoma may be an option, even in patients with underlying cirrhosis. Patients with more advanced disease who undergo major hepatic resection have improved outcomes compared with those who are not candidates for other treatments because of disease extent, including transplantation. Resectable patients with early HCC and underlying liver disease are increasingly being considered for transplantation because of potential for better disease-free survival and resolution of underlying liver disease, though this approach is limited by organ availability, especially in resectable patients.

Options for surgical resection are in part determined by the severity of underlying liver disease, which is reflected by the Child-Pugh classification (table 1) or the Model for End-stage Liver Disease (MELD) score, which is a prospectively developed and validated chronic liver disease severity scoring system to predict survival (calculator 1). (See "Assessing surgical risk in patients with liver disease", section on 'MELD score' and "Model for End-stage Liver Disease (MELD)".)

Surgical resection of HCC will be reviewed here. The clinical manifestations and diagnosis of HCC, an overview of the treatment approach to HCC, nonsurgical local ablative options, liver transplantation, and adjuvant and neoadjuvant therapy are reviewed elsewhere.

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

(See "Overview of treatment approaches for hepatocellular carcinoma".)

                

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