Hepatocellular carcinoma (HCC) incidence is growing among general population and especially in elderly patients. Recent development in surgical technique, surgical equipment, interventional radiology, and radiotherapy (hadrontherapy) allows us to use different techniques and approaches in order to treat this cancer. Patients are conventionally considered disease-free after a 10-year recurrence-free period. Commonly, patients remain into a lifelong follow-up and recurrences are treated as they show. In this chapter, we will give description and indications of different curative techniques, especially hepatic resections and Radio-frequency thermal ablation (RFTA). We will also describe and give indications to palliative care techniques such as transarterial chemoembolization (TACE), Selective Internal Radio-Therapy (SIRT), hadrontherapy, and supportive care. The aim of this chapter is to give information to clinicians and specialists dealing with the disease about the most effective approach to treat HCC, taking into account not only biological age, but also “physiological age,” performance status, comorbidities, and number of liver operative treatments. This chapter highlights that patients advanced in age are in particular need of a tailored medicine, where benefits are well weighted against invasivity of treatment and its side effects, in spite of assuring the best QoL and survival.
Part of the book: Liver Cancer
In this chapter we aim at presenting the state of the art in liver surgery. After a brief introduction about natural evolution of hepatocellular carcinoma (HCC) either in cirrhotic or non-cirrhotic patients, this manuscript will focus on planning and timing surgery: CT evaluation of the remnant liver; biopsy and ultrasonography (US) evaluation of liver disease; intraoperative US; surgical techniques, such as major and limited hepatectomies and two-stage hepatectomies, each of them in open or mini-invasive approach; and their possible complications. Follow-up and further interventions during expected recurrences will be highlighted. Our chapter will also treat topics such as patient’s quality of life, importance of multidisciplinary evaluation and the role of surgeon in it.
Part of the book: Liver Disease and Surgery