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12 - Surgical Management (Resection)

from PART III - ORGAN-SPECIFIC CANCERS

Published online by Cambridge University Press:  18 May 2010

By
Brian D. Badgwell ,
Dario Ribero  and
Jean-Nicolas Vauthey
Edited by
Jean-François H. Geschwind  and
Michael C. Soulen
Brian D. Badgwell
Affiliation:
Surgical Oncology Fellow, Department of Surgical Oncology M.D. Anderson Cancer Center University of Texas Houston, TX
Dario Ribero
Affiliation:
Clinical Fellow, M.D. Anderson Cancer Center University of Texas Houston, TX
Jean-Nicolas Vauthey
Affiliation:
Professor of Surgery and Chief of the Liver Service, Department of Surgical Oncology M.D. Anderson Cancer Center University of Texas Houston, TX
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
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Summary

Hepatocellular carcinoma (HCC) is the fifth most common neoplasm worldwide, affecting more than 600,000 people annually (1). Though less prevalent in the United States, the estimated annual number of cases exceeds 16,000. Moreover, despite a decline in alcoholic liver disease and increased use of hepatitis B immunization strategies, the incidence in our country is steadily rising and has doubled between 1975 and 1998, likely due to an increase in hepatitis C virus infection (2). In the majority of patients, HCC develops in fibrotic/cirrhotic livers, and cirrhosis represents the strongest predisposing factor.

The natural history of untreated HCC varies depending on the stage at presentation and the degree of underlying liver disease. However, even in patients with early stages, the prognosis is grim if the disease is left untreated (3, 4). As primary medical therapy has failed to significantly improve survival, surgical resection and orthotopic liver transplantation (OLT) represent the only treatment options, offering a prospect for cure with 5-year survival rates of up to 50% (5–7) and 70% (8, 9), respectively.

Unfortunately, only approximately 20% to 40% (10, 11) of patients are candidates for resection due to the burden of hepatic tumor, the presence of extrahepatic spread or the extent of underlying liver disease. Despite this, liver resections are increasingly being performed due to better perioperative care, improved imaging and advances in surgical technique.

Type
Chapter
Information
Interventional Oncology
Principles and Practice
 , pp. 121 - 134
Publisher: Cambridge University Press
Print publication year: 2008

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  • Surgical Management (Resection)
    • By Brian D. Badgwell, Surgical Oncology Fellow, Department of Surgical Oncology M.D. Anderson Cancer Center University of Texas Houston, TX, Dario Ribero, Clinical Fellow, M.D. Anderson Cancer Center University of Texas Houston, TX, Jean-Nicolas Vauthey, Professor of Surgery and Chief of the Liver Service, Department of Surgical Oncology M.D. Anderson Cancer Center University of Texas Houston, TX
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.013
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  • Surgical Management (Resection)
    • By Brian D. Badgwell, Surgical Oncology Fellow, Department of Surgical Oncology M.D. Anderson Cancer Center University of Texas Houston, TX, Dario Ribero, Clinical Fellow, M.D. Anderson Cancer Center University of Texas Houston, TX, Jean-Nicolas Vauthey, Professor of Surgery and Chief of the Liver Service, Department of Surgical Oncology M.D. Anderson Cancer Center University of Texas Houston, TX
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.013
Available formats
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  • Surgical Management (Resection)
    • By Brian D. Badgwell, Surgical Oncology Fellow, Department of Surgical Oncology M.D. Anderson Cancer Center University of Texas Houston, TX, Dario Ribero, Clinical Fellow, M.D. Anderson Cancer Center University of Texas Houston, TX, Jean-Nicolas Vauthey, Professor of Surgery and Chief of the Liver Service, Department of Surgical Oncology M.D. Anderson Cancer Center University of Texas Houston, TX
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.013
Available formats
×