[Surgical treatment of hepatocellular carcinoma].
There are two principal aspects to surgical treatment of hepatocellular carcinoma, hepatectomy and transplantation. Transplantation is a treatment of the tumor and the underlying liver disease. When discovered in a <<healthy>> liver, hepatocellular carcinoma is often seen as a large tumor. Resection is indicated if there is no bilobar diffusion or metastasis. If the liver is <<diseased>>, liver resection is contraindicated in case of liver failure or atrophy. In patients with no liver failure (Child-Pugh A), bi-segmentary resection can be proposed. In the long run, the causes of mortality after resection for hepatocellular carcinoma are mainly subsequent to tumor recurrence. Transplantation is a priori the best possible treatment for small sized hepatocellular carcinoma developing on a chronically ill liver. For several reasons, this option cannot however be proposed for all patients: limited number of liver grafts available, high operative mortality around 10%. In addition, the risk of recurrence of the causal liver disease, particularly in case of hepatitis B and C infections, is high. Finally, even if the initial tumor is a unique small-sized lesion, the risk of recurrence is favored by the immunosuppression required for tolerance after liver transplantation.
Belghiti
J
J
Fédération de pathologie digestive, Hôpital Beaujon, Clichy. jacques.belghiti@bjn.ap-hp-paris.fr
D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000075202:Contraindications; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D009367:Neoplasm Staging; D018579:Patient Selection; D012307:Risk Factors