Surgical Approaches to Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) ranks among the leading causes of cancer mortality worldwide, and surgical resection remains a cornerstone of curative therapy in patients with preserved liver function. Surgical options broadly divide into anatomical resection (AR) and non-anatomical resection (NAR). Anatomical resection entails removal of the tumour-bearing portal territory, theoretically eradicating microsatellite lesions and reducing intrahepatic recurrence. Non-anatomical resection, often termed wedge or limited resection, preserves more parenchyma and may be preferred in cirrhotic patients with marginal hepatic reserve. Advances in preoperative imaging, intraoperative navigation and parenchymal transection technology have refined both techniques, allowing more precise margin assessment and minimising blood loss. Selection of resection type balances tumour characteristics—such as size, number, location and vascular invasion—against liver function and future remnant volume. Increasingly, machine-learning models are being explored to personalise the choice of resection and predict postoperative outcomes. Despite numerous retrospective studies and meta-analyses, controversy persists regarding survival benefit versus preservation of hepatic reserve, particularly in tumours smaller than 5 cm or with microvascular invasion. Recent work has also focused on enhancing safety through techniques such as precise hepatic pedicle dissection, while debates continue over optimal margin width and the role of laparoscopic and robotic approaches for both AR and NAR. Overall, surgical management of HCC demands integration of tumour biology, hepatic function assessment and technological innovation to deliver tailored, curative treatment.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Surgical Approaches to Hepatocellular Carcinoma publication trend

The graph below shows the total number of articles in surgical approaches to hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Anatomical resection (AR): Removal of the entire liver segment or subsegment based on portal vein territories to eradicate potential micrometastases.

Non-anatomical resection (NAR): Local excision of the tumour with a margin of normal parenchyma, sparing uninvolved liver tissue.

Microvascular invasion (MVI): Presence of cancer cells within small vessels in the liver parenchyma, indicating aggressive tumour biology.

Recurrence-free survival (RFS): Time interval after surgery during which the patient remains free from detectable tumour recurrence.

Propensity score matching: Statistical technique to balance clinical and demographic factors between treatment groups in observational studies.

References

1. Data-Driven Assisted Decision Making for Surgical Procedure of Hepatocellular Carcinoma Resection and Prognostic Prediction: Development and Validation of Machine Learning Models. Cancers (2023).
2. Propensity score analysis demonstrated the prognostic advantage of anatomical liver resection in hepatocellular carcinoma. World Journal of Gastroenterology (2014).
3. Prognostic value of precise hepatic pedicle dissection in anatomical resection for patients with hepatocellular carcinoma. Medicine (2020).
4. Oncological outcomes of anatomic versus non-anatomic resections for small hepatocellular carcinoma: systematic review and meta-analysis of propensity-score matched studies. World Journal of Surgical Oncology (2022).