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World J Clin Cases. May 26, 2021; 9(15): 3517-3530
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3517
Surgical treatment of hepatocellular carcinoma in the era of COVID-19 pandemic: A comprehensive review of current recommendations
Alessandro Fancellu, Valeria Sanna, Fabrizio Scognamillo, Claudio F Feo, Gianpaolo Vidili, Giuseppe Nigri, Alberto Porcu
Alessandro Fancellu, Claudio F Feo, Alberto Porcu, Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
Valeria Sanna, Unit of Medical Oncology, AOU Sassari, Sassari 07100, Italy
Fabrizio Scognamillo, Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 1 - Patologia Chirurgica, University of Sassari, Sassari 07100, Italy
Gianpaolo Vidili, Department of Medical, Surgical and Experimental Sciences, Unit of Internal Medicine, University of Sassari, Sassari 07100, Italy
Giuseppe Nigri, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, St. Andrea University Hospital, Rome 00189, Italy
Author contributions: Fancellu A, Sanna V and Porcu A contributed to this paper with conception and study design, manuscript writing and critical revision; Scognamillo F, Feo CF and Nigri G contributed with literature review and analysis, drafting and critical revision/editing; all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors do not have any conflicts of interest relevant to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alessandro Fancellu, FACS, MD, PhD, Associate Professor, Research Scientist, Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, V.le San Pietro 43, Sassari 07100, Italy. afancel@uniss.it
Received: January 24, 2021
Peer-review started: January 24, 2021
First decision: February 22, 2021
Revised: March 2, 2021
Accepted: April 21, 2021
Article in press: April 21, 2021
Published online: May 26, 2021
Processing time: 106 Days and 21 Hours
Abstract

The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a global health emergency that has also caused profound changes in the treatment of cancer. The management of hepatocellular carcinoma (HCC) across the world has been modified according to the scarcity of care resources that have been diverted mostly to face the surge of hospitalized COVID-19 patients. Oncological and hepatobiliary societies have drafted recommendations regarding the adaptation of guidelines for the management of HCC to the current healthcare situation. This review focuses on specific recommendations for the surgical treatment of HCC (i.e., hepatic resection and liver transplantation), which still represents the best chance of cure for patients with very early and early HCC. While surgery should be pursued for very selected patients in institutions where standards of care are maintained, alternative or bridging methods, mostly thermoablation and transarterial therapies, can be used until surgery can be performed. The prognosis of patients with HCC largely depends on both the characteristics of the tumour and the stage of underlying liver disease. Risk stratification plays a pivotal role in determining the most appropriate treatment for each case and needs to balance the chance of cure and the risk of COVID-19 infection during hospitalization. Current recommendations have been critically reviewed to provide a reference for best practices in the clinical setting, with adaptation based on pandemic trends and categorization according to COVID-19 prevalence.

Keywords: Hepatocellular carcinoma; COVID-19; Hepatic resection; Liver transplant; Ablation

Core Tip: Guidelines on the surgical management of hepatocellular carcinoma have been recently adapted to the prioritization of health resources to the care of patients with coronavirus disease 2019 (COVID-19). There has been a reduction in hepatic resection and liver transplant activity, which need to be restricted to very selected cases. For patients in whom surgery cannot be performed in due time, alternative or delaying strategies, mostly ablation or transarterial therapies, should be considered. The decision on surgical management should be based on risk stratification and the balance between the increased risk of COVID-19 infection, the urgency of the intervention, and the oncological effects of delayed treatment and shared with patients.