Part of the book: Understanding the Complexities of Kidney Transplantation
Cirrhosis is an increasing cause of morbidity and mortality in more developed countries, being the 14th most common cause of death worldwide. Hepatocellular carcinoma (HCC) consists a significant health issue worldwide, responsible for more than 1 million deaths annually. The incidence and mortality rates vary across different geographical areas. Between 60 and 90% of HCC patients already have liver cirrhosis, attributed mainly to chronic hepatitis B and C, alcohol abuse, and non-alcoholic fatty liver disease (NASH). The surgical management of HCC in the setting of liver cirrhosis with curative intent includes liver resection, ablation or microwave coagulation, and liver transplantation (LT). Liver resection in a cirrhotic liver with HCC is associated with lower survival rates compared with liver transplantation (LT), depending on the diseases’ stage but on the contrary liver resection could be potentially offered in a larger population compared to liver transplantation. One of the biggest limitations of liver resection is the risk of tumor recurrence, which is high, and it may exceed 70% 5 years after the procedure. Liver transplantation is considered the best treatment for hepatocellular carcinoma at early stages because it removes the tumor as well as the underlying cirrhotic liver.
Part of the book: Liver Cirrhosis
Surgical resection is the gold standard for hepatocellular carcinoma management for early stages of the disease. With advances in technology and techniques, minimally invasive surgery provides a great number of advantages for these patients during their surgery and for their post-operative care. The selection of patients following a multi-disciplinary approach is of paramount importance. Adding to this, the developments in laparoscopic instruments and training, as well as the promising advantages of robotic surgery along with other forms of technology, increase the pool of patients that can undergo operation safely and with good results worldwide. We review results from great centres worldwide and delineate the accurate multi-disciplinary approach for this.
Part of the book: Hepatocellular Carcinoma