, Volume 17, Issue 5, pp 1219-1225
Date: 20 Apr 2010

Surgical Resection of High-Risk Hepatocellular Carcinoma: Patient Selection, Preoperative Considerations, and Operative Technique

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Hepatocellular carcinoma remains a leading cause of cancer death worldwide. There are an increasing number of patients that do not meet traditional criteria for surgical resection as a result of historically poor outcomes. We define these oncologically high-risk patients as those with either one of these risk factors or a combination of them: large (>5 cm) primary tumors, multinodular disease, and/or major vascular invasion. With appropriate selection and preparation, long-term survival is possible in this subset of patients after resection. This review focuses on the surgical treatment of these high-risk patients, focusing on our own institution’s approach and methods as well as reviewing the literature pertinent to the support of our current practice.