Surgical technique: new advances for expanding indications and increasing safety in liver resection for HCC - The Eastern perspective

We introduce recent advances in surgical techniques and perioperative management in liver resection for hepatocellular carcinoma (HCC). Our approaches to further enhancing the efficacy of resection for HCC, based on our presentation at The 6th International Meeting of Hepatocellular Carcinoma: Eastern and Western Experiences held in Seoul in December 2008, are presented, along with a review of recent advances in this field reported from eastern Asia. In our series, liver resection enabled a 5-year overall survival rate of close to 60%, even among patients with multiple HCCs and those with portal hypertension in a background of Child-Pugh class A cirrhosis. Favorable long-term results were obtained by the precise evaluation of liver function using the indocyanine green (ICG) test and the application of perioperative treatments for gastroesophageal varices and severe thrombocytopenia. Furthermore, promising novel techniques have been applied to increase the efficacy of HCC resection, including the preoperative simulation of liver resection, using three-dimensional computed tomography, a peeling-off technique for resecting HCC with macroscopic portal venous tumor thrombus, ICG-fluorescent imaging, predeposit autologous plasma transfusion, and laparoscopic liver resection. The safety and accuracy of liver resection for HCC has been continuously enhanced by advances in surgical techniques and perioperative care. Given that the resection of HCC offers a satisfactory overall survival rate for patients with portal hypertension and those with oligonodular multiple tumors, the surgical indications can now be expanded to include such second-best candidates.