37. Surgical Options in Liver Cancers

  1. Eugene R. Schiff MD, MACP, FRCP2,
  2. Willis C. Maddrey MD, MACP, FRCP3 and
  3. Michael F. Sorrell MD, FACP4
  1. B. Daniel Campos MD and
  2. Jean F. Botha MD

Published Online: 31 OCT 2011

DOI: 10.1002/9781119950509.ch37

Schiff's Diseases of the Liver, Eleventh Edition

Schiff's Diseases of the Liver, Eleventh Edition

How to Cite

Campos, B. D. and Botha, J. F. (2011) Surgical Options in Liver Cancers, in Schiff's Diseases of the Liver, Eleventh Edition (eds E. R. Schiff, W. C. Maddrey and M. F. Sorrell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119950509.ch37

Editor Information

  1. 2

    Center for Liver Diseases and Schiff Liver Institute, University of Miami Miller School of Medicine, Miami, FL, USA

  2. 3

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. 4

    University of Nebraska College of Medicine, Omaha, NE, USA

Author Information

  1. Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA

Publication History

  1. Published Online: 31 OCT 2011
  2. Published Print: 9 DEC 2011

ISBN Information

Print ISBN: 9780470654682

Online ISBN: 9781119950509

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Keywords:

  • Hepatocellular carcinoma (HCC);
  • cholangiocarcinoma;
  • hepatectomy;
  • extended hepatectomy;
  • hemihepatectomy;
  • liver transplantation;
  • pancreatoduodenectomy;
  • radiofrequency ablation (RFA);
  • transarterial chemoembolization (TACE);
  • percutaneous ethanol injection (PEI)

Summary

Hepatocellular carcinoma (HCC) and cholangiocarcinoma are the two most common primary hepatic malignancies. Successful and timely surgical management is the only hope for long-term survival. HCC arises in a background of cirrhosis in the majority of patients. Surgical resection of HCC by means of a partial hepatectomy is an adequate treatment when restricted to noncirrhotic patients or to patients with a very early stage of cirrhosis. Liver transplantation is currently the best treatment for patients with HCC and cirrhosis. The best outcomes are obtained when its application is limited to patients with a single tumor less than 5 cm across or three tumors each less than 3 cm. Expansion of these criteria for transplantation is currently under debate. Pretransplant locoregional therapy in the form of radiofrequency ablation (RFA), transarterial chemoembolization (TACE), and percutaneous ethanol injection is indicated in patients awaiting transplantation. TACE and RFA successfully downstage HCC tumors, expanding the transplantability window for these patients. However, these therapies have failed to clearly demonstrate a reproducible benefit in terms of long-term survival or dropout rates from the waiting list. The surgical management of cholangiocarcinoma depends on its location along the biliary tree. Intrahepatic tumors are treated by a partial hepatectomy; distal tumors are treated by a pancreatoduodenectomy. Hilar tumors (the most common location) are best treated by an extended hepatectomy or by liver transplantation when unresectable. Despite continuous improvement in anesthesia, surgery, and oncology the outcomes in the treatment of cholangiocarcinoma remain poor. The addition of pretransplant chemoradiation therapy has remarkably improved the outcome of liver transplantation in the treatment of hilar cholangiocarcinoma. Liver transplantation, although not applicable to most patients with HCC or cholangiocarcinoma, has revolutionized their prognosis offering a greater than 75% chance of survival at 4 years.