Hepatocellular carcinoma surgery: From resection to transplantation: Current and future indications [Chirurgie du carcinome hépatocellulaire : de l'exérèse à la transplantation : indications actuelles et futures]

摘要

Primary malignant tumor of the liver, hepatocellular carcinoma (HCC) occurs almost always with an underlying chronic liver disease, commonly but not necessarily at cirrhosis stage. In developed countries, chronic hepatitis C and nonalcoholic fatty liver disease frequently associated with metabolic syndrome are the major risk factors for HCC,thus explaining its increasing incidence in the recent years. Liver transplantation, liver resection and radiofrequency ablation are the three potentially curative therapeutic possibilities available for the treatment of HCC. The choice of treatment depends on the following factors: a nontumorous liver, age, comorbidities of the patient, and size and number of the lesions. Liver transplantation (LT) appears to be the best theoretical treatment for removing all lesions with optimal margins and treating the underlying liver disease at the same time. However, graft shortage and stringent selection criteria for oncological reasons hamper its use in all patients. More than 10 years after their adoption by the transplant community, Milan criteria remain the corner stone of the indications of LT for HCC. Liver resection (LR) is an alternative option, particularly to treat HCC without cirrhosis or as a bridging therapy to LT. However, its significant operative risk and high rate of recurrence need to be considered before treatment. Radiofrequency ablation helps in the treatment of early-stage HCC with lower morbidity than LR, but its efficiency is impaired by the size of the lesion. Although LT offers the best chance for cure it is not suitable for all patients, and indications of treatment is still a matter of debate. Recent advances in molecular biology of the tumor and non-tumorous liver should help to better assess prognosis and thus to refine indications.