Hepatocellular carcinoma is malignancy that originates from the liver.

Physical signs are hepatomegaly and ascites. It is usually asymptomatic for much of its natural history.

Liver cancer is the second most common cause of cancer-related mortality worldwide & hepatocellular carcinoma accounts for >90% of liver cancers.


Surgical Intervention

Principles of Therapy
  • If the patient has good liver function (Child Pugh A or early B, good ICG retention at 15 minutes), adequate liver remnant & good general health, he/she is a good candidate for liver resection
  • Liver transplantation can be considered in selected patients w/ early hepatocellular carcinoma w/ good liver function after multidisciplinary assessment (eg when future liver remnant (FLR) is marginally adequate or where vascular margins are close
  • Initial treatment w/ either partial hepatectomy/liver resection or transplantation should be considered in patients w/ liver function characterized by a Child-Pugh class A score, lack of portal hypertension & who fit the UNOS criteria
    • The patient should also have an operable disease on the basis of performance status & comorbidity
Liver Resection
  • Involves surgical removal of functional liver parenchyma in the setting of underlying liver disease
  • A potentially curative therapy for patients w/ single tumor of any size w/ no evidence of gross vascular invasion
  • A potentially curative treatment option & is the preferred treatment for patients w/ the following disease characteristics:
    • Adequate liver function (Child-Pugh class A & selected Child-Pugh class B patients w/ no portal hypertension)
    • Single tumor w/ no major vascular invasion
    • Adequate liver remnant
Liver Transplantation
  • Removes both detectable & undetectable tumor lesions, treats underlying liver cirrhosis, & avoids surgical complications associated w/ a small FLR
  • Generally, it can be considered as an initial treatment of choice for patients w/ early-stage hepatocellular carcinoma & moderate-to-severe cirrhosis if liver graft is available
  • Should be considered for patients who meet the UNOS criteria
  • In contrast to liver resection, there is no restriction for the indication of liver transplantation, at least in terms of liver function, & liver transplantation, which could potentially cure both the diseased liver & hepatocellular carcinoma, is superior to any other conventional therapeutic options
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