Current role of surgical treatment in hepatocellular carcinoma

Background Hepatocellular carcinoma (HCC) is the most frequent primary carcinoma of the liver with an increasing incidence worldwide and the second most common cause of cancer-related death overall. Since about 90% of all HCCs occur in the setting of liver cirrhosis or, at least, chronically diseased livers, treatment stratification has to consider not only cancer-related factors but also the patient's liver function as well as their overall condition and physical performance. Objectives This review provides an overview of surgical treatments for HCC, particularly in patients with cirrhosis. Methods A selective review of the literature was performed in the PubMed database. Results and conclusion Following the national and international HCC guidelines, the Barcelona Clinic Liver Cancer (BCLC) classification serves as basis for treatment decision-making. However, with regard to the improvement of surgical treatment, an expansion of the indications for liver resection and liver transplantation seems reasonable in the future. After appropriate patient selection based on tumor size and location as well as tumor markers, surgery may also be oncologically beneficial for patients in an intermediate or advanced stage. In this regard, laparoscopic resection should be evaluated especially for patients in whom liver transplantation is planned or the tumor is easily accessible. In Germany, an extension of prioritization for patients with HCC and liver cirrhosis after an appropriate downstaging for liver transplantation is currently not possible. Due to the multiple treatment options, the individual evaluation of each patient should be made in an interdisciplinary tumor conference with an experienced interventional oncologist or radiologist, as well as a hepatobiliary surgeon.