From minimal to maximal surgery in the treatment ofhepatocarcinoma： A review

• Published in: 世界肝病学杂志：英文版（电子版） 2015 (1), p.93-100
• Main Author: Marcos Vinicius Perini Graham Starkey Michael A Fink Ramesh Bhandari Vijayaragavan Muralidharan Robert Jones Christopher Christophi
• Format: Article
• Language: English
• Subjects: carcinoma; Cirrhosis; Liver; Hepatectomy; Hepatocellular; Liver; resection; Survival; transplantation
• ISSN: 1948-5182; 1948-5182

Hepatocellular carcinoma represents one of the mostchallenging frontiers in liver surgery. Surgeons have toface a broad spectrum of aspects, from the underlyingliver disease to the new surgical techniques. Safe liverresection can be performed in patients with portalhypertension and well-compensated liver function witha 5-year survival rate of 50%, offering good longtermsresults in selected patients. With the advancesin laparoscopic surgery, major liver resections can beperformed with minimal harm, avoiding the woundand leak complications related to the laparotomies.Studies have shown that oncological margins are thesame as in open surgery. In patients submitted to liverresection （either laparoscopic or open） who experiencerecurrence, re-resection or salvage liver transplantationhas been showing to be an alternative approach in wellselected cases. The decision making approach to thecirrhotic patient is becoming more complex and shouldinvolve hepatologists, liver surgeons, radiologists andoncologists. Better understanding of the different riskfactors for recurrence and survival should be aimed inthese multidisciplinary discussions. We here in discussthe hot topics related to surgical risk factors regardingthe surgical treatment of hepatocellular carcinomaanatomical resection, margin status, macrovasculartumor invasion, the place of laparoscopy, salvage livertransplantation and liver transplantation.