Salvage surgery following downstaging of unresectable hepatocellular carcinoma--a strategy to increase resectability.
BACKGROUND
Surgical resection with complete extirpation of the tumor gives the best chance of a cure for patients with hepatocellular carcinoma (HCC). However, the resectability of HCC at the time of diagnosis is low (10-30%). This article reviews the use of salvage surgery following tumor downstaging to treat unresectable HCC.


METHODS
A Medline search was undertaken from 1966 to 2005 to identify articles using the keywords "liver neoplasm," "hepatocellular carcinoma," "tumor downstaging," and "unresectable." Additional papers were identified by a manual search of the references from the key articles.


RESULTS
Eight to eighteen percent of patients with unresectable HCC responded well enough to the initial palliative treatment to downstage HCC to allow salvage surgical resection. The reported five-year survival rate after salvage surgery following tumor downstaging varied from 24.9 to 57%.


CONCLUSIONS
Although it is still unknown whether the outcome of salvage surgery following tumor downstaging is comparable to those of resectable tumors after primary resection, one clear message is that salvage surgery following tumor downstaging gives good long-term results and the possibility of a cure in a proportion of patients with unresectable HCC. The role of salvage surgery after tumor downstaging in improving disease-free and overall survival in patients with unresectable HCC should be investigated further by prospective randomized controlled trials.
Lau
Wan Yee
WY
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China. josephlau@cuhk.edu.hk
Lai
Eric C H
EC
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D016879:Salvage Therapy