New Surgical Approaches in the Treatment of Hepatocellular Carcinoma

New advances in the treatment of HCC have emerged in recent years. The implementation of surveillance programmes has led to better diagnosis of HCC at early stages. Liver resection and liver transplantation remain the only potentially curative treatment options that can be applied in a limited number of patients resulting in 5-year survival rates as high as 75 - 80%. Resection is indicated in patients with limited disease and absence of cirrhosis. Liver transplantation is beneficial in patients with cirrhosis and tumour size according to the Milan criteria. Organ donor shortage and the consequently long waiting time limits its applicability. TACE and radiofrequency ablation provide local tumour control in unresectable HCC and are increasingly used in addition to tumour resection. The major drawback of all treatments is the risk for local tumour recurrence or tumour progress during the waiting time for transplantation. The application of sorafenib in the (neo-)adjuvant situation is being tested in clinical trials.