Asian Perspectives and Controversies in Surgical Management of Hepatocellular Carcinoma: How Far Have We Come?
Long-Bin Jeng, Ashok Thorat, Horng-Ren Yang
Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
Med Sci Rev 2016; 3:73-84
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most frequent cause of cancer-related deaths worldwide. Patients with cirrhosis are at high risk of developing HCC. The incidence of HCC is highest in Asia and Africa, where the endemic high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) strongly predisposes to the development of chronic liver disease and subsequent development of HCC. The treatment of HCC depends upon the stage of liver disease and underlying liver functions that allow safe resection of tumor-bearing liver tissue. Liver resection, liver transplantation (LT), and certain locoregional therapies are the potentially curative treatment options available for the patients with early-stage HCC. However, liver resection benefits patients transiently, as recurrence of HCC after curative resection is common. The current reported 5-year survival rate after liver resection is 30–60%. LT is most beneficial for individuals who are not good candidates for resection, especially those within Milan criteria (a solitary tumor ≤5 cm and up to 3 tumors ≤3 cm). The donor shortage greatly limits its applicability, but LT offers a greater chance of cure by removing both the underlying liver cirrhosis and HCC. Variety of locoregional treatment options is available, which includes transarterial chemoembolization (TACE), radio-frequency ablation (RFA), and percutaneous ethanol injection (PEI). These are used either as palliative or bridging therapies for wait-listed liver transplant candidates. The use of different therapeutic approaches such as liver resection or LT largely depends on the experience of the center, the availability of the donor organs, and clinical condition of the patient. Advances in treatment options, multidisciplinary approach, and better understanding of the disease process have led to increased short-term survival of HCC patients. This review article describes current trends in surgical management of HCC and current Asian perspectives in managing HCC patients.
Keywords: Carcinoma, Hepatocellular, Catheter Ablation, Liver Transplantation