Surgical treatment of hepatocellular carcinoma

There are two principal aspects to surgical treatment of hepatocellular carcinoma, hepatectomy and transplantation. Transplantation is a treatment of the tumor and the underlying liver disease. When discovered in a "healthy" liver, hepatocellular carcinoma is often seen as a large tumor. Resection is indicated if there is no bilobar diffusion or metastasis. If the liver is "diseased", liver resection is contraindicated in case of liver failure or atrophy. In patients with no liver failure (Child-Pugh A), bi-segmentary resection can be proposed. In the tong run, the causes of mortality after resection for hepatocellular carcinoma are mainly subsequent to tumor recurrence. Transplantation is a priori the best possible treatment for small sized hepatocellular carcinoma developing on a chronically ill liver. For several reasons, this option cannot however be proposed for all patients: limited number of liver grafts available, high operative mortality around 10%. In addition, the risk of recurrence of the causal liver disease, particularly in case of hepatitis B and C infections, is high. Finally, even if the initial tumor is a unique small-sized lesion, the risk of recurrence is favored by the immunosuppression required for tolerance after liver transplantation.