Hepatocellular carcinoma (HCC) is the main common primary tumour of the liver and it is usually associated with cirrhosis. The barcelona clinic liver cancer (BCLC) classification has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver and the American Association for the Study of Liver Disease. According to this algorithm, hepatic resection should be performed only in patients with small single tumours of 2-3 cm without signs of portal hypertension (PHT) or hyperbilirubinemia. BCLC classification has been criticised and many studies have shown that multiple tumors and large tumors, as wide as those with macrovascular infiltration and PHT, could benefit from liver resection. Consequently, treatment guidelines should be revised and patients with intermediate/advanced stage HCC, when technically resectable, should receive the opportunity to be treated with radical surgical treatment. Nevertheless, the surgical treatment of HCC on cirrhosis is complex: The goal to be oncologically radical has always to be balanced with the necessity to minimize organ damage. The aim of this review was to analyze when and how liver resection could be indicated beyond BCLC indication. In particular, the role of multidisciplinary approach to assure a proper indication, of the intraoperative ultrasound for intraoperative restaging and resection guidance and of laparoscopy to minimize surgical trauma have been enhanced.

Garancini, M., Pinotti, E., Nespoli, S., Romano, F., Gianotti, L., Giardini, V. (2016). Hepatic resection beyond barcelona clinic liver cancer indication: When and how. WORLD JOURNAL OF HEPATOLOGY, 8(11), 513-519 [10.4254/wjh.v8.i11.513].

Hepatic resection beyond barcelona clinic liver cancer indication: When and how

GARANCINI, MATTIA
;
PINOTTI, ENRICO
Secondo
;
ROMANO, FABRIZIO;GIANOTTI, LUCA VITTORIO
Penultimo
;
GIARDINI, VITTORIO
Ultimo
2016

Abstract

Hepatocellular carcinoma (HCC) is the main common primary tumour of the liver and it is usually associated with cirrhosis. The barcelona clinic liver cancer (BCLC) classification has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver and the American Association for the Study of Liver Disease. According to this algorithm, hepatic resection should be performed only in patients with small single tumours of 2-3 cm without signs of portal hypertension (PHT) or hyperbilirubinemia. BCLC classification has been criticised and many studies have shown that multiple tumors and large tumors, as wide as those with macrovascular infiltration and PHT, could benefit from liver resection. Consequently, treatment guidelines should be revised and patients with intermediate/advanced stage HCC, when technically resectable, should receive the opportunity to be treated with radical surgical treatment. Nevertheless, the surgical treatment of HCC on cirrhosis is complex: The goal to be oncologically radical has always to be balanced with the necessity to minimize organ damage. The aim of this review was to analyze when and how liver resection could be indicated beyond BCLC indication. In particular, the role of multidisciplinary approach to assure a proper indication, of the intraoperative ultrasound for intraoperative restaging and resection guidance and of laparoscopy to minimize surgical trauma have been enhanced.
Articolo in rivista - Review Essay
Barcelona clinic liver cancer; Cirrhosis; Hepatic resection; Hepatocellular carcinoma; Intraoperative ultrasound; Laparoscopy; Liver surgery; Multidisciplinary approach; Multiple hepatocellular carcinoma; Portal hypertension;
Barcelona clinic liver cancer; Cirrhosis; Hepatic resection; Hepatocellular carcinoma; Intraoperative ultrasound; Laparoscopy; Liver surgery; Multidisciplinary approach; Multiple hepatocellular carcinoma; Portal hypertension; Hepatology
English
18-apr-2016
2016
8
11
513
519
none
Garancini, M., Pinotti, E., Nespoli, S., Romano, F., Gianotti, L., Giardini, V. (2016). Hepatic resection beyond barcelona clinic liver cancer indication: When and how. WORLD JOURNAL OF HEPATOLOGY, 8(11), 513-519 [10.4254/wjh.v8.i11.513].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/139014
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