title: Hepatocellular carcinoma: surgical perspectives beyond the barcelona clinic liver cancer recommendations.
abstract: The barcelona clinic liver cancer (BCLC) staging system has been approved as guidance for hepatocellular carcinoma (HCC) treatment guidelines by the main Western clinical liver associations. According to the BCLC classification, only patients with a small single HCC nodule without signs of portal hypertension or hyperbilirubinemia should undergo liver resection. In contrast, patients with intermediate-advanced HCC should be scheduled for palliative therapies, even if the lesion is resectable. Recent studies report good short-term and long-term outcomes in patients with intermediate-advanced HCC treated by liver resection. Therefore, this classification has been criticised because it excludes many patients who could benefit from curative resection. The aim of this review was to evaluate the role of surgery beyond the BCLC recommendations. Safe liver resection can be performed in patients with portal hypertension and well-compensated liver function with a 5-year survival rate of 50%. Surgery also offers good long-term result in selected patients with multiple or large HCCs with a reported 5-year survival rate of over 50% and 40%, respectively. Although macrovascular invasion is associated with a poor prognosis, liver resection provides better long-term results than palliative therapies or best supportive care. Recently, researchers have identified several genes whose altered expression influences the prognosis of patients with HCC. These genes may be useful for classifying the biological behaviour of different tumours. A revision of the BCLC classification should be introduced to provide the best treatment strategy and to ensure the best prognosis in patients with HCC.
authors: Alfredo Guglielmi, Andrea Ruzzenente, Simone Conci, Alessandro Valdegamberi, Marco Vitali, Francesca Bertuzzo, Michela De Angelis, Guido Mantovani, Calogero Iacono, Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary surgery, University of Verona Medical School, 37134 Verona, Italy.
authors: Alfredo
authors: A
authors: Guglielmi
authors: Alfredo Guglielmi, Andrea Ruzzenente, Simone Conci, Alessandro Valdegamberi, Marco Vitali, Francesca Bertuzzo, Michela De Angelis, Guido Mantovani, Calogero Iacono, Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary surgery, University of Verona Medical School, 37134 Verona, Italy.
authors: Andrea
authors: A
authors: Ruzzenente
authors: Alfredo Guglielmi, Andrea Ruzzenente, Simone Conci, Alessandro Valdegamberi, Marco Vitali, Francesca Bertuzzo, Michela De Angelis, Guido Mantovani, Calogero Iacono, Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary surgery, University of Verona Medical School, 37134 Verona, Italy.
authors: Simone
authors: S
authors: Conci
authors: Alfredo Guglielmi, Andrea Ruzzenente, Simone Conci, Alessandro Valdegamberi, Marco Vitali, Francesca Bertuzzo, Michela De Angelis, Guido Mantovani, Calogero Iacono, Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary surgery, University of Verona Medical School, 37134 Verona, Italy.
authors: Alessandro
authors: A
authors: Valdegamberi
authors: Alfredo Guglielmi, Andrea Ruzzenente, Simone Conci, Alessandro Valdegamberi, Marco Vitali, Francesca Bertuzzo, Michela De Angelis, Guido Mantovani, Calogero Iacono, Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary surgery, University of Verona Medical School, 37134 Verona, Italy.
authors: Marco
authors: M
authors: Vitali
authors: Alfredo Guglielmi, Andrea Ruzzenente, Simone Conci, Alessandro Valdegamberi, Marco Vitali, Francesca Bertuzzo, Michela De Angelis, Guido Mantovani, Calogero Iacono, Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary surgery, University of Verona Medical School, 37134 Verona, Italy.
authors: Francesca
authors: F
authors: Bertuzzo
authors: Alfredo Guglielmi, Andrea Ruzzenente, Simone Conci, Alessandro Valdegamberi, Marco Vitali, Francesca Bertuzzo, Michela De Angelis, Guido Mantovani, Calogero Iacono, Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary surgery, University of Verona Medical School, 37134 Verona, Italy.
authors: Michela
authors: M
authors: De Angelis
authors: Alfredo Guglielmi, Andrea Ruzzenente, Simone Conci, Alessandro Valdegamberi, Marco Vitali, Francesca Bertuzzo, Michela De Angelis, Guido Mantovani, Calogero Iacono, Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary surgery, University of Verona Medical School, 37134 Verona, Italy.
authors: Guido
authors: G
authors: Mantovani
authors: Alfredo Guglielmi, Andrea Ruzzenente, Simone Conci, Alessandro Valdegamberi, Marco Vitali, Francesca Bertuzzo, Michela De Angelis, Guido Mantovani, Calogero Iacono, Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary surgery, University of Verona Medical School, 37134 Verona, Italy.
authors: Calogero
authors: C
authors: Iacono
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003661:Decision Support Techniques; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D009367:Neoplasm Staging / Q000379:methods*; D010166:Palliative Care; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Barcelona clinic liver cancer; Hepatectomy; Hepatocellular carcinoma; Liver resection; Surgical therapy