Scientific Hepatectomy for Hepatocellular Carcinoma

With advances in imaging technology and surgical instruments,hepatectomy can be perfectly performed with technical precision for hepatocellular carcinoma(HCC).However,the 5-year tumor recurrence rates remain greater than 70%.Thus,the strategy for hepatectomy needs to be reappraised based on insights of scientific advances.Scientific evidence has suggested that the main causes of recurrence after hepatectomy for HCC are mainly related to underlying cirrhosis and the vascular spread of tumor cells that basically cannot be eradicated by hepatectomy.Liver transplantation and systemic therapy could be the solution to prevent postoperative recurrence in this regard.Therefore,determining the severity of liver cirrhosis for choosing the appropriate surgical modality,such as liver transplantation or hepatectomy,for HCC and integrating newly emerging immune-related adjuvant and/or neoadjuvant therapy into the strategy of hepatectomy for HCC have become new aspects of exploration to optimize the strategy of hepatectomy.In this new area,hepatectomy for HCC has evolved from a pure technical concept emphasizing anatomic resection into a scientific concept embracing technical considerations and scientific advances in underlying liver cirrhosis,vascular invasion,and systemic therapy.By introducing the concept of scientific hepatectomy,the indications,timing,and surgical techniques of hepatectomy will be further scientifically optimized for individual patients,and recurrence rates will be decreased and long-term survival will be further prolonged.

Treatment for hepatocellular carcinoma with tumor thrombosis in the hepatic vein or inferior vena cava:A comprehensive review

Hepatocellular carcinoma(HCC)is the most common type of liver cancer with a high mortality rate worldwide.The percentage of HCC patients with vascular invasion is high.However,tumor thrombus in the hepatic vein(HVTT)has a lower incidence than tumor thrombus in the portal vein(PVTT).Conventionally,HCC patients with HVTT are treated the same as HCC patients with PVTT and offered sorafenib or other systemic agents.However,according to recent studies,it is evident that HCC with HVTT shows different outcomes when classified into different subgroups.In this review,we discuss the recent progress and changes in treatment of HCC with HVTT.

Surgery for hepatocellular carcinoma with tumor thrombosis in inferior vena cava: A case report

BACKGROUND Hepatocellular carcinoma(HCC)accompanied by a tumor thrombus is very common.However,the treatment strategy is controversial and varies by the location of the thrombus.CASE SUMMARY We report herein a case of HCC with a tumor thrombus in the suprahepatic inferior vena cava(IVC),which was successfully treated by hepatectomy combined with thrombectomy following sorafenib chemotherapy.A 47-year-old woman with chronic hepatitis was diagnosed with HCC.Computed tomography and magnetic resonance imaging showed that the tumor lesion was located in the right half of the liver,and a tumor thrombus was detected in the suprahepatic IVC near the right atrium.After multi-departmental discussion and patient informed consent,right major hepatectomy and total removal of the tumor thrombus were successfully performed under cardiopulmonary bypass.There were no serious complications after surgery.Following sorafenib treatment,no recurrence has been detected so far(11 mo later).CONCLUSION Surgical treatment followed by adjuvant sorafenib therapy might be an acceptable choice for HCC patients with tumor thrombosis in the IVC.

Splenectomy may facilitate systemic therapy for advanced hepatocellular carcinoma with hypersplenism

Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related deaths globally and is widely considered to be a serious threat to human health.In clinical settings,more than 70%of HCCs are unresectable at initial diagnosis and are therefore treated with palliative rather than curative treatment,which severely reduces the overall survival of HCC patients(1).