Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2015; 7(2): 245-252
Published online Feb 27, 2015. doi: 10.4254/wjh.v7.i2.245
Surgical management of hepatocellular carcinoma
Tony CY Pang, Vincent WT Lam
Tony CY Pang, Vincent WT Lam, Department of Surgery, Westmead Hospital, Westmead NSW 2145, Australia
Tony CY Pang, Vincent WT Lam, Western Clinical School, Sydney Medical School, University of Sydney, Westmead NSW 2145, Australia
Author contributions: Both authors contributed to this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Vincent WT Lam, Associate Professor, Department of Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead NSW 2145, Australia.
Telephone: +61-2-9845697 Fax: +61-2-98937440
Received: August 27, 2014
Peer-review started: August 29, 2014
First decision: October 14, 2014
Revised: October 21, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 27, 2015

Hepatocellular carcinoma (HCC) is the second most common cause of death from cancer worldwide. Standard potentially curative treatments are either resection or transplantation. The aim of this paper is to provide an overview of the surgical management of HCC, as well as highlight current issues in hepatic resection and transplantation. In summary, due to the relationship between HCC and chronic liver disease, the management of HCC depends both on tumour-related and hepatic function-related considerations. As such, HCC is currently managed largely through non-surgical means as the criteria, in relation to the above considerations, for surgical management is still largely restrictive. For early stage tumours, both resection and transplantation offer fairly good survival outcomes (5 years overall survival of around 50%). Selection therefore would depend on the level of hepatic function derangement, organ availability and local expertise. Patients with intermediate stage cancers have limited options, with resection being the only potential for cure. Otherwise, locoregional therapy with transarterial chemoembolization or radiofrequency ablation are viable options. Current issues in resection and transplantation are also briefly discussed such as laparoscopic resection, ablation vs resection, anatomical vs non-anatomical resection, transplantation vs resection, living donor liver transplantation and salvage liver transplantation.

Keywords: Hepatocellular carcinoma, Liver surgery, Liver resection, Liver transplantation, Laparoscopic liver surgery

Core tip: Surgical management through either resection or transplantation are the only potentially curative treatment for hepatocellular carcinoma. The decision for the management strategy depends on tumour factors, hepatic functional reserve, organ availability, wait time as well as local expertise and resources.