Published online Apr 18, 2016. doi: 10.4254/wjh.v8.i11.513
Peer-review started: September 11, 2015
First decision: October 27, 2015
Revised: February 18, 2016
Accepted: March 24, 2016
Article in press: March 25, 2016
Published online: April 18, 2016
Core tip: According to the barcelona clinic liver cancer (BCLC) classification liver resection should be performed only in patients with small single hepatocellular carcinoma of 2-3 cm without signs of portal hypertension (PHT). Nevertheless, many studies have shown that patients with multiple and large hepatocellular carcinoma, as like as those with macrovascular infiltration and PHT, could benefit from liver resection. Consequently BCLC algorithm should be updated and revised. The aim of this review was to analyze when and how liver resection could be indicated beyond BCLC indications. In this perspective, the role of multidisciplinary approach, of intraoperative ultrasound and of laparoscopy have been enhanced.