title: Recent advances in the surgical treatment of hepatocellular carcinoma.
abstract: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. The treatment of HCC is complex and complicated by the severity of associated chronic liver disease, the stage of HCC, and the clinical condition of the patient. Liver resection (LR) is one of the most efficient treatments for patients with HCC, with an expected 5-year survival of 38%-61% depending on the stage of the disease. Improved liver function assessment, increased understanding of segmental liver anatomy from advanced imaging studies, and surgical technical progress are important factors that have led to reduced mortality in patients with HCC. The indication for LR may be expanded due to emerging evidences from laparoscopic hepatectomies and combined treatments with newly developed chemotherapies. Liver transplantation (LT) is considered as an ideal treatment for removal of existing tumors and the injured/preneoplastic underlying liver tissue with impaired liver function and the risk of multicentric carcinogenesis that results from chronically injured liver. However, LT is restricted to patients with minimal risk of tumor recurrence under immunosuppression. The expansion of criteria for LT in HCC patients is still under trial and discussion. Limited availability of grafts, as well as the risk and the cost of transplantation have led to considerable interest in expansion of the donor pool, living donor-related transplantation, and combined treatment involving LR and LT. This highlight presents evidence concerning recent studies evaluating LR and LT in HCC patients. In addition, alternative therapies for the treatment of early stage tumors and the management of patients on transplant waiting lists are discussed.
authors.affiliation: Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Nagoya 454-8509, Japan.
authors.forename: Zenichi
authors.initials: Z
authors.lastname: Morise
authors.affiliation: Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Nagoya 454-8509, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Kawabe
authors.affiliation: Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Nagoya 454-8509, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tomishige
authors.affiliation: Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Nagoya 454-8509, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Nagata
authors.affiliation: Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Nagoya 454-8509, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Kawase
authors.affiliation: Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Nagoya 454-8509, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Arakawa
authors.affiliation: Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Nagoya 454-8509, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Yoshida
authors.affiliation: Zenichi Morise, Norihiko Kawabe, Hirokazu Tomishige, Hidetoshi Nagata, Jin Kawase, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Nagoya 454-8509, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Isetani
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D004621:Embolization, Therapeutic; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Chemotherapy; Hepatectomy; Hepatocellular carcinoma; Laparoscopic hepatectomy; Liver transplantation; Surgical treatment; Tumor thrombi