Surgical Management of Hepatocellular Carcinoma (HCC)

The European Association for the Study of the Liver (EASL) in 2001 and the American Association for Liver Diseases (AASLD) in 2005 followed the Barcelona - Clinic Liver Cancer (BCLC) staging classification and treatment schedule. Surgical resection can be offered for patients who have a single lesion if they are not cirrhotic or have cirrhosis and still have well-preserved liver function, normal bilirubin and hepatic vein pressure <10 mmHg (level II). But the Japanese Practice Guideline reported by the Japanese Society of Hepatology in 2007 recommended surgical resection for 2 or 3 tumors no more than 3 cm in diameter, even in cases with 4 or more lesions. The differences in practice guidelines between these two areas come from different cultural situations, especially in the availability of transplantation. Our results from hepatic resection in 834 patients with HCC from 1992 to 2004 at Seoul National University Hospital were as follows: 1) After surgical resection, the favorable prognostic group are patients with tumor size less than 10 cm in size without major vessel invasion. 2) Surgical resection is recommended in the favorable group of patients with oligonodular tumors. 3) Surgical resection is not indicated for patients with major vessel tumor invasion or portal hypertension. In the AASLD guidelines, liver transplantation is an effective option for patients with HCC, corresponding to the Milan criteria: solitary <5 cm or up to three nodules <3 cm (level II), and a living donor transplantation can be offered for HCC if the waiting time is long enough to allow tumor progression leading to exclusion from the waiting list (level II). Japanese Practice Guidelines restrict liver transplantation to patients under the age of 65. The role of salvage liver transplantation is still controversial. Early detection and the development of therapeutic agents for metastases by microvascular tumor invasion are important for increasing survival of HCC patients.

간세포암의 외과적 치료