Introduction
Hepatocellular carcinoma is a liver cancer that commonly requires surgical treatment. The major surgical techniques include a partial liver section or liver transplantation. Methods have improved to increase patient outcomes and reduce all possible complications. The article discusses the various surgical treatments for hepatocellular carcinoma and their recent associated advancements.
What Is Hepatocellular Carcinoma?
Hepatocellular carcinoma, a prevalent form of primary liver cancer, is frequent in individuals with chronic liver conditions, such as liver cirrhosis resulting from hepatitis B or C infections. It is commonly seen among those with prolonged liver disease. A primary risk factor is excessive alcohol consumption, often observed in individuals who consume substantial amounts of alcohol and accumulate fat in the liver.
The disease is diagnosed during screening or when patients experience symptoms associated with liver issues, including abdominal pain, discomfort, enlarged abdomen, weight loss, jaundice, gastrointestinal bleeding, nausea or persistent vomiting, itching, and fever. Early detection is important for effective management.
How to Manage Hepatocellular Carcinoma?
The treatment for hepatocellular carcinoma depends on various factors, including tumor size, location, liver function, and overall patient health. Preparing a treatment plan for hepatocellular carcinoma is a complex process that demands a personalized approach involving collaboration among multiple specialty doctors. Over recent years, there has been significant progress in the surgical management of hepatocellular carcinoma. Surgical procedures, especially in patients with intermediate and advanced stages, have shown success, with minimally invasive surgery contributing to a positive prognosis. The integration of interventional radiology has further elevated the success rate of surgeries. Treatment options for hepatocellular carcinoma include:
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Surgery: Surgical removal of the cancerous tumor, along with a margin of surrounding healthy tissue, aims to prevent recurrence and manage early-stage liver cancer. This procedure is important for maintaining normal liver function.
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Liver Transplant Surgery: In cases where the cancer has not spread beyond the liver and other treatment options are limited, liver transplant surgery involves removing the entire liver and replacing it with a healthy donor liver tissue. This becomes a vital option for individuals facing a life-threatening situation.
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Destruction of Cancer Cells with Heat or Cold: Ablation procedures employ extreme heat or cold to kill liver cancer cells. This is a suitable alternative for those ineligible for surgery. Procedures include radiofrequency ablation, cryo-ablation, and ablation using alcohol or microwaves.
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Chemotherapy, Radiation, or Radiation Therapy: Direct delivery of chemotherapy drugs or targeted radiation to cancer cells is done. Radiation therapy utilizes energy from X-rays or protons, with a specialized form known as stereotactic body radiotherapy focusing concentrated radiation at specific points in the body.
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Targeted Drug Therapy: Targeted drugs cause specific weaknesses in cancer cells, slowing down the progression of the disease, particularly in cases of advanced liver disease.
Why Is Surgical Treatment Important for Hepatocellular Carcinoma?
Surgery is a key treatment for liver cancer. Liver transplantation is effective for small tumors, but strict criteria, organ scarcity, and high costs limit its use. For larger tumors, liver resection (removing part or all of the liver) is an option, with increasing safety. However, partial resection has a higher recurrence risk. It is optimal for small tumors, removing the tumor and underlying disease, but faces challenges like limited grafts and costs. Decision factors vary. Liver cancer can also occur without chronic liver disease (five to 15 percent of cases). Major hepatic resection is adequate, especially for fibrolamellar carcinoma, with up to 5-year disease-free survival and 50 percent success rates.
In cases with chronic liver disease, surgery aims for a cure while minimizing risks. Liver resection is indicated if there's no extrahepatic metastasis, multiple tumors, or main duct involvement. Extensive resection can be positive in selected cases with good liver function.
Complications include spontaneous rupture of large tumors, and liver tumors larger than 10 cm are not recommended for resection.
What Are the Recent Advancements in Liver Surgery for Hepatocellular Carcinoma?
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Minimally Invasive Techniques: Recent advancements in liver surgery for hepatocellular carcinoma include the widespread adoption of minimally invasive techniques such as laparoscopic and robotic surgeries. These procedures involve small incisions, leading to a reduction in post-operative pain. Additionally, they contribute to minimizing recovery time and lowering the overall risk of complications.
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Image-Guided Navigation: Advanced imaging techniques in liver surgery have revolutionized the field. Intraoperative imaging, a key innovation, allows real-time visualization of the liver and tumor. This technology enables surgeons to monitor and guide the procedure accurately, ensuring precise tumor removal while preserving healthy tissue.
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Ablative Therapies: A significant breakthrough in liver surgery involves the utilization of ablative therapies, specifically radiofrequency and microwave ablation. These techniques utilize heat to effectively destroy cancerous tissue, providing an alternative for patients ineligible for surgery. This approach offers a less invasive option with favorable outcomes.
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Precision Medicine: The emergence of precision medicine has become a cornerstone in managing hepatocellular carcinoma. Molecular profiling, a personalized treatment approach based on the tumor's molecular characteristics, has become commonplace. This innovative method tailors therapies to the tumor's specific genetic makeup, significantly improving treatment efficacy.
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Virtual Surgical Planning: Virtual surgical planning through advanced computer simulations and virtual reality technologies has transformed preoperative preparations. These technologies allow surgeons to plan and simulate complex liver surgeries before entering the operating room. This not only enhances precision but also significantly reduces the risk of complications.
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Intraoperative Monitoring: Real-time monitoring during liver surgery has become possible through electrophysiological monitoring. This advanced technique monitors liver function and blood flow throughout the surgery. The real-time data enables immediate adjustments, ensuring optimal conditions for tumor removal and preserving healthy liver tissue.
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Post-Operative Care Innovations: Post-operative care results in a more favorable prognosis. Enhanced recovery after surgery (ERAS) protocols have gained prominence, focusing on optimizing post-operative care. This approach emphasizes early mobilization, effective pain management, and optimal nutrition, contributing to faster recovery and complications.
Conclusion
Hepatocellular carcinoma necessitates liver surgery, which can take the form of either partial liver resection or complete hepatic tomich (transplantation) for the patient's survival. The choice of the surgical method is carefully planned, considering factors such as the severity of the disease, the patient's health, and potential risk factors. Over time, diverse techniques have emerged to mitigate complications associated with surgery. Furthermore, introducing newer methods has significantly reduced postoperative complications, fostering improved healing and enhancing the patient's overall well-being.
