Deshpande Rahul, O'Reilly Derek, Sherlock David
Department of Hepatobiliary Surgery, North Manchester General Hospital, Crumpsall, Manchester M8 5RB, UK.
Int J Hepatol. 2011;2011:686074. doi: 10.4061/2011/686074. Epub 2011 Jun 12.
With rising incidence and emergence of effective treatment options, the management of hepatocellular carcinoma (HCC) is a complex multidisciplinary process. There is still little consensus and uniformity about clinicopathological staging systems. Resection and liver transplantation have been the cornerstone of curative surgical treatments with recent emergence of ablative techniques. Improvements in diagnostics, surgical techniques, and postoperative care have lead to dramatically improved results over the years. The most appropriate treatment plan has to be individualised and depends on a variety of patient and tumour-related factors. Very small HCCs discovered on surveillance have the best outcomes. Patients with advanced cirrhosis and tumours within Milan criteria should be offered transplantation. Resection is best for small solitary tumours with preserved liver function. Ablative techniques are suitable for low volume tumours in patients unfit for either resection or transplantation. The role of downstaging and bridging therapy is not clearly established.
随着肝细胞癌（HCC）发病率的上升以及有效治疗方案的出现，肝细胞癌的管理是一个复杂的多学科过程。关于临床病理分期系统，目前仍存在很少的共识和一致性。手术切除和肝移植一直是根治性外科治疗的基石，近年来出现了消融技术。多年来，诊断、手术技术和术后护理的改进带来了显著改善的结果。最合适的治疗方案必须个体化，并且取决于多种患者和肿瘤相关因素。在监测中发现的非常小的肝细胞癌预后最佳。符合米兰标准的晚期肝硬化和肿瘤患者应接受移植。手术切除最适合肝功能良好的小的孤立性肿瘤。消融技术适用于不适合手术切除或移植的患者的小体积肿瘤。降期和桥接治疗的作用尚未明确确立。
