7 - The role of surgery in the treatment of hepatocellular carcinoma and hepatic metastases

Summary

Introduction

The role of surgery in the treatment of primary hepatocellular carcinoma (HCC) and hepatic metastases has evolved greatly over the last two decades due to the increasing safety of liver surgery and to the emergence of viable alternative treatments, such as tumor ablation and liver transplantation. In this chapter, we will summarize the current data supporting the use of partial hepatectomy in the treatment of primary and secondary malignancies. In particular, we will highlight the evolving and complementary roles of hepatectomy, ablation, and transplantation in the increasingly effective treatment of patients with liver cancers.

Recent reports demonstrating increasing safety of hepatectomy for cancer

When managing HCC and hepatic metastases, the technical advances in liver surgery and the technological advances in ablation modalities have made surgery a more effective part of the treatment regimen in these patients. Recent improvements in perioperative outcomes following liver resection have been well documented. In 2002, Jarnagin et al. reviewed 1803 liver resections including 544 trisegmentectomies, 483 lobectomies, and 526 segmental resections. The median hospital stay in these patients was 8 days, and only 112 (6%) spent time in the intensive care unit. In this cohort the operative mortality was 3.1%, with no deaths in the last 184 consecutive cases.

These improvements have also been shown following hepatectomy for HCC.