Surgical management of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is among the three most common causes of cancer death worldwide. Liver resection and liver transplantation are regarded as the standard curative treatment for hepatocellular carcinoma. Although liver transplantation for early stage hepatocellular carcinoma has been shown to have excellent long-term survival outcomes and low recurrence rates, the shortage of donor liver grafts limits its wide application. Liver resection can be safely performed in patients with early stage hepatocellular carcinoma and preserved liver function. Although postoperative recurrence after liver resection of hepatocellular carcinoma is almost universal, the reported five-year overall survival rates are around 50%. Recently, the concept of primary liver resection and salvage liver transplantation has been proposed in patients with early stage hepatocellular carcinoma and preserved liver function. Universal adoption of either liver resection or liver transplantation for hepatocellular carcinoma is unwarranted and overly simplistic. The use of different therapeutic approaches that incorporate liver resection or liver transplantation, depends not only on the availability of donor liver grafts and waiting time, but also on the expertise of individual centres.