Resection and transplantation for hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Abstract

Treatment of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) has markedly improved in recent years. Liver resection and, for HCC, liver transplantation are essential components of curative treatment in the nonmetastatic stage. In the current S3guideline, the role of the interdisciplinary tumor board is strengthened for the individual therapy decision. Overall, liver transplantation offers the best long-term results in terms of survival and relapse rate for selected patients. For liver resection, the use of minimally invasive resection techniques can significantly reduce perioperative morbidity and mortality compared to open liver surgery, so that it can be used both as acurative therapeutic approach and as part of bridging strategies for liver transplantation. The 5‑year survival rate after liver transplantation in selected, nonresectable patients who fulfil and also those who do not fulfil the Milan criteria is above 70%, compared with about 30% without liver transplantation under locoregional therapy. The following article reports the status of evidence-based surgical therapy for HCC and iCCA based on the recommendations of the current German S3guideline. The differentiated local therapy of HCC in cirrhosis is based on many patient- and tumor-specific factors. In addition to surgical resection, liver transplantation plays an important role as acurative therapy for patients with irresectable HCCs regardless of whether they meet the Milan criteria. For resectable iCCA or HCC without cirrhosis in the nonmetastatic stage, surgical resection represents the treatment of choice.