Surgical resection is an optimal curative approach to hepatocarcinoma. When transplantation is not feasible, hepatectomy is the first choice to effectively treat HCC. The 5-year overall survival for the disease stages that benefit from this approach, ranges from 50 to 70%. Unfortunately, only 20-30% of patients are eligible for curative intervention. Moreover, the 5-year-recurrence rate after surgery is close to 70%. Over the last decades, the attempt to reduce recurrence rate, together with a more thorough understanding of the mechanism underlying this phenomenon has lead experts to ask themselves what the best surgical procedure could be. Defining the right extent of the resection is often difficult and unequivocal guidelines have yet to be established. Currently, most international guidelines suggest that the anatomic resection (AR) of a liver segment may allow the removal of the segmental portal bed, preventing microvascular invasion and satellitosis which may be the cause of intrahepatic metastasization (currently ranging between 20 and 70%). Nevertheless, many reports have shown a similar rate of local recurrence (almost 15%) in cases of parenchymasparing resection (PSR), where the cancer nodule is removed regardless of the portal segment extension. A recent meta-analysis showed no significant differences in recurrence rate in the two procedures (RR 1.28, 95%CI: 0.59-2.76; p:0.53). No clear advantages can be proven in terms of overall survival, either: the 5-year overall survival rate is 64.9% for AR and 61.1% for PSR. Moreover, PSR was proved to be a safe and oncologically correct technique for cirrhotic patients, for whom preserving as much parenchyma as possible is mandatory to reduce the impact of postoperative liver failure or ascites. In this chapter, we will focus on the indications to surgery in HCC, on how to perform a liver resection, and on the different indications to the two main surgical approaches to hepatocellular carcinoma. We will discuss long-term outcomes; different theories on the causes of recurrence after resection, and how this evidence could possibly lead to an extension of the indications to a surgical curative approach in primary liver carcinoma.
Famularo, S., Giani, A., Uggeri, F., Ciulli, C., Nespoli, L., Bianco, G., et al. (2020). THE ROLE OF SURGICAL RESECTION IN HEPATOCELLULAR CARCINOMA: ANATOMIC VERSUS PARENCHYMA-SPARING RESECTION AND THEIR ONCOLOGICAL OUTCOMES. In Encyclopedia of Surgery: Volume 1: (22 Volume Set) (pp. 2333-2361). Nova Science Publishers, Inc..
THE ROLE OF SURGICAL RESECTION IN HEPATOCELLULAR CARCINOMA: ANATOMIC VERSUS PARENCHYMA-SPARING RESECTION AND THEIR ONCOLOGICAL OUTCOMES
Uggeri F.;Nespoli L.;Gianotti L.;Romano F.
2020
Abstract
Surgical resection is an optimal curative approach to hepatocarcinoma. When transplantation is not feasible, hepatectomy is the first choice to effectively treat HCC. The 5-year overall survival for the disease stages that benefit from this approach, ranges from 50 to 70%. Unfortunately, only 20-30% of patients are eligible for curative intervention. Moreover, the 5-year-recurrence rate after surgery is close to 70%. Over the last decades, the attempt to reduce recurrence rate, together with a more thorough understanding of the mechanism underlying this phenomenon has lead experts to ask themselves what the best surgical procedure could be. Defining the right extent of the resection is often difficult and unequivocal guidelines have yet to be established. Currently, most international guidelines suggest that the anatomic resection (AR) of a liver segment may allow the removal of the segmental portal bed, preventing microvascular invasion and satellitosis which may be the cause of intrahepatic metastasization (currently ranging between 20 and 70%). Nevertheless, many reports have shown a similar rate of local recurrence (almost 15%) in cases of parenchymasparing resection (PSR), where the cancer nodule is removed regardless of the portal segment extension. A recent meta-analysis showed no significant differences in recurrence rate in the two procedures (RR 1.28, 95%CI: 0.59-2.76; p:0.53). No clear advantages can be proven in terms of overall survival, either: the 5-year overall survival rate is 64.9% for AR and 61.1% for PSR. Moreover, PSR was proved to be a safe and oncologically correct technique for cirrhotic patients, for whom preserving as much parenchyma as possible is mandatory to reduce the impact of postoperative liver failure or ascites. In this chapter, we will focus on the indications to surgery in HCC, on how to perform a liver resection, and on the different indications to the two main surgical approaches to hepatocellular carcinoma. We will discuss long-term outcomes; different theories on the causes of recurrence after resection, and how this evidence could possibly lead to an extension of the indications to a surgical curative approach in primary liver carcinoma.
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