Liver Resection and Surgical Strategies for Management of Primary Liver Cancer
Top Cited Papers
Open Access
- 31 December 2017
- journal article
- review article
- Published by SAGE Publications in Cancer Control
- Vol. 25 (1)
- https://doi.org/10.1177/1073274817744621
Abstract
Primary liver cancer—including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC)—incidence is increasing and is an important source of cancer-related mortality worldwide. Management of these cancers, even when localized, is challenging due to the association with underlying liver disease and the complex anatomy of the liver. Although for ICC, surgical resection provides the only potential cure, for HCC, the risks and benefits of the multiple curative intent options must be considered to individualize treatment based upon tumor factors, baseline liver function, and the functional status of the patient. The principles of surgical resection for both HCC and ICC include margin-negative resections with preservation of adequate function of the residual liver. As the safety of surgical resection has improved in recent years, the role of liver resection for HCC has expanded to include selected patients with preserved liver function and small tumors (ablation as an alternative), tumors within Milan criteria (transplant as an alternative), and patients with large (>5 cm) and giant (>10 cm) HCC or with poor prognostic features (for whom surgery is infrequently offered) due to a survival benefit with resection for selected patients. An important surgical consideration specifically for ICC includes the high risk of nodal metastasis, for which portal lymphadenectomy is recommended at the time of hepatectomy for staging. For both diseases, onco-surgical strategies including portal vein embolization and parenchymal-sparing resections have increased the number of patients eligible for curative liver resection by improving patient outcomes. Multidisciplinary evaluation is critical in the management of patients with primary liver cancer to provide and coordinate the best treatments possible for these patients.Keywords
This publication has 118 references indexed in Scilit:
- Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysisBMC Gastroenterology, 2013
- EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinomaEuropean Journal of Cancer, 2012
- Which is more cost‐effective under the MELD system: primary liver transplantation, or salvage transplantation after hepatic resection or after loco‐regional therapy for hepatocellular carcinoma within Milan criteria?HPB, 2011
- Influence of Surgical Margins on Outcome in Patients With Intrahepatic CholangiocarcinomaAnnals of Surgery, 2011
- Risk factors for cholangiocarcinomaJournal of Hepatology, 2011
- Management of hepatocellular carcinoma: An updateJournal of Hepatology, 2011
- Minor versus major hepatic resection for small hepatocellular carcinoma (HCC) in cirrhotic patients: A 20-year experienceSurgery, 2010
- Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinomaHepatology International, 2010
- Strategies for Resection Using Portal Vein Embolization: Hepatocellular Carcinoma and Hilar CholangiocarcinomaSeminars in Interventional Radiology, 2008
- Anterior Approach Versus Conventional Approach Right Hepatic Resection for Large Hepatocellular CarcinomaAnnals of Surgery, 2006