Surgical resection of high-risk hepatocellular carcinoma: patient selection, preoperative considerations, and operative technique.
Hepatocellular carcinoma remains a leading cause of cancer death worldwide. There are an increasing number of patients that do not meet traditional criteria for surgical resection as a result of historically poor outcomes. We define these oncologically high-risk patients as those with either one of these risk factors or a combination of them: large (>5 cm) primary tumors, multinodular disease, and/or major vascular invasion. With appropriate selection and preparation, long-term survival is possible in this subset of patients after resection. This review focuses on the surgical treatment of these high-risk patients, focusing on our own institution's approach and methods as well as reviewing the literature pertinent to the support of our current practice.
Truty
Mark J
MJ
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Vauthey
Jean-Nicolas
JN
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D018579:Patient Selection; D011300:Preoperative Care; D013514:Surgical Procedures, Operative / Q000379:methods*
Hepatology. 1997 Nov;26(5):1176-81
9362359
J Am Coll Surg. 2007 Sep;205(3):453-62
17765162
J Gastrointest Surg. 2008 Jan;12(1):123-8
17924174
Hepatology. 2002 Mar;35(3):519-24
11870363
Hepatology. 1999 Dec;30(6):1434-40
10573522
Hepatogastroenterology. 2002 Mar-Apr;49(44):518-23
11995486
N Engl J Med. 2008 Jul 24;359(4):378-90
18650514
Ann Surg. 1999 Jan;229(1):84-90
9923804
Ann Surg. 2001 Mar;233(3):379-84
11224626
Ann Surg. 2003 Feb;237(2):208-17
12560779
Ann Surg Oncol. 2003 Nov;10(9):1070-6
14597446
Ann Surg. 1989 Jan;209(1):88-98
2535924
Hepatogastroenterology. 1993 Aug;40(4):328-32
8406301
Ann Surg. 2001 Feb;233(2):236-41
11176130
Semin Oncol. 2001 Oct;28(5):514-20
11685744
J Formos Med Assoc. 2008 Aug;107(8):616-26
18678545
Cancer. 2002 Jan 15;94(2):421-7
11905412
Surg Oncol Clin N Am. 2003 Jan;12(1):65-75, ix
12735130
World J Surg. 2006 Jun;30(6):992-9
16736327
Arch Surg. 2001 May;136(5):528-35
11343543
Semin Liver Dis. 1999;19(3):329-38
10518312
Ann Surg. 1999 Jun;229(6):790-9; discussion 799-800
10363892
J Am Coll Surg. 2007 Feb;204(2):329-33
17254939
J Hepatol. 1995 Jun;22(6):696-9
7560864
Br J Surg. 1996 Sep;83(9):1219-22
8983610
Gastroenterology. 2009 Sep;137(3):850-5
19524573
Br J Surg. 2006 Sep;93(9):1091-8
16779884
J Am Coll Surg. 2002 May;194(5):592-602
12022599
Arch Surg. 2005 May;140(5):450-7; discussion 457-8
15897440
J Am Coll Surg. 2001 Jul;193(1):109-11
11442247
Liver Transpl. 2001 Jul;7(7):631-6
11460231
N Engl J Med. 1996 Mar 14;334(11):693-9
8594428
Cancer. 1999 Oct 1;86(7):1151-8
10506698
World J Surg. 1986 Oct;10(5):803-8
3022488
Ann Surg. 2006 Aug;244(2):194-203
16858181
Am J Clin Oncol. 1998 Aug;21(4):386-91
9708639
Hepatology. 2001 May;33(5):1080-6
11343235
Hepatology. 2003 Dec;38(6):1449-57
14647056
J Clin Oncol. 2002 Mar 15;20(6):1527-36
11896101
Hepatology. 1999 Jan;29(1):62-7
9862851
Am J Surg. 2001 Apr;181(4):347-53
11438270
Surgery. 2005 Apr;137(4):403-10
15800485
Arch Surg. 2004 Jul;139(7):766-74
15249411
J Hepatol. 1999 Dec;31(6):1062-8
10604580
Ann Surg Oncol. 2005 May;12(5):364-73
15915370
Hepatogastroenterology. 2009 May-Jun;56(91-92):768-72
19621699
Liver Transpl. 2002 Mar;8(3):233-40
11910568
Liver Transpl. 2005 Sep;11(9):1086-92
16123959
Surgery. 2009 Apr;145(4):399-405
19303988
Hepatogastroenterology. 1999 Jan-Feb;46(25):413-6
10228832
Gastroenterology. 1996 Oct;111(4):1018-22
8831597
Gastroenterology. 2008 Jun;134(7):1908-16
18549877
Ann Surg. 1993 Apr;217(4):375-84
8385442