Resektion und Lebertransplantation bei hepatozellulärem Karzinom

Abstract

Background: Curative strategies for hepatocellular carcinoma (HCC) are liver resection and transplantation. The Barcelona Clinic Liver Cancer Group (BCLC) classification is the basis for therapeutic stratification. Method: This overview is based on a selective literature search on therapeutic strategies for HCC. Guidelines of different societies were taken into account while new surgical approaches were especially evaluated. Results: Primary resectable HCCs should be resected. Most patients without cirrhosis qualify for resection. A liver resection should be considered for patients with Child A cirrhosis but without severe portal hypertension and a stable health status. It is of utmost importance that resectability is evaluated in a designated liver center. Intrahepatic tumor recurrences can also be re-resected or listed for liver transplantation. New techniques for extended liver resections or minimally invasive liver resections are commonly used and need to be studied further. Conclusion: In addition to liver resection, liver transplantation represents a standard therapy for HCC in cirrhosis today. Whilst observing selection criteria, 5-year survival rates of 70-90% can be achieved. However, increasing organ shortage leads to longer waiting times and thus to a higher risk of tumor progress. Thus, if possible, patients eligible for transplantation could be primarily resected as a bridging therapy as well as biological stratification. Liver transplantation should then be offered as a 'rescue transplantation' if recurrence under close monitoring occurs. However, even patients with tumors in an advanced stage for which transplantation is not possible or too late can be resected with encouraging results. Therefore, the resection criteria according to the BCLC classification could be extended. Copyright © 2013 S. Karger AG, Basel.