Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Surgical management, including hepatic resection, liver transplantation, and ablation, offers the greatest potential for a curative approach. This review aims to discuss recent advancements in HCC surgery and identify unresolved issues in the field. Treatment selection relies on the BCLC staging system, with surgical therapies primarily recommended for early-stage disease. Recent studies have shown that patients previously considered unresectable, such as those with portal vein tumor thrombus and uncomplicated portal hypertension, may benefit from hepatic resection. Minimally invasive surgery and improved visualization techniques are also explored, alongside new techniques for optimizing future liver remnant, ex vivo resection, and advancements in hemorrhage control. Liver transplantation criteria, particularly the long-standing Milan criteria, are critically examined. Alternative criteria proposed and tested in specific regions are presented. In the context of organ shortage, bridging therapy plays a critical role in preventing tumor progression and maintaining patients eligible for transplantation. Lastly, we explore emerging ablation modalities, comparing them with the current standard, radiofrequency ablation. In conclusion, this comprehensive review provides insights into recent trends and future prospects in the surgical management of HCC, highlighting areas that require further investigation.
肝细胞癌是全球癌症相关死亡的主要原因。以肝切除术、肝移植和消融术为代表的外科干预是实现根治性治疗的最有效手段。本综述旨在探讨肝细胞癌外科治疗的最新进展，并指出该领域尚未解决的问题。治疗方案选择主要依据巴塞罗那临床肝癌分期系统，外科治疗主要推荐用于早期疾病。最新研究表明，既往被认为不可切除的患者（如合并门静脉癌栓或代偿性门静脉高压者）可能从肝切除术中获益。本文同时探讨了微创手术与可视化技术的改进，以及优化未来肝残余体积、离体肝切除的创新技术和出血控制方面的进展。针对肝移植标准，特别是长期应用的米兰标准进行了批判性评估，并介绍了特定地区提出和验证的替代标准。在器官短缺背景下，桥接治疗对防止肿瘤进展、维持患者移植资格具有关键作用。最后，我们探讨了新兴消融模式，并将其与当前标准射频消融术进行比较。总之，本综述全面阐述了肝细胞癌外科治疗的最新趋势与未来前景，并指明了需要进一步研究的领域。
Current Trends in Surgical Management of Hepatocellular Carcinoma
肿瘤(癌症)患者之家