Takamoto Takeshi, Mihara Yuichirou, Nishioka Yujirou, Ichida Akihiko, Kawaguchi Yoshikuni, Akamatsu Nobuhisa, Hasegawa Kiyoshi
Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Int J Clin Oncol. 2025 Mar;30(3):417-426. doi: 10.1007/s10147-025-02703-7. Epub 2025 Feb 5.
Hepatocellular carcinoma (HCC) remains a significant global health challenge, with over 800,000 new cases diagnosed annually. This comprehensive review examines current surgical approaches and emerging multidisciplinary strategies in HCC treatment. While traditional surgical criteria, such as the Barcelona Clinic Liver Cancer (BCLC) staging system, have been relatively conservative, recent evidence from high-volume Asian centers supports more aggressive surgical approaches in carefully selected patients. The review discusses the evolution of selection criteria, including the new "Borderline Resectable HCC" classification system, which provides more explicit guidance for surgical decision-making. Technical innovations have significantly enhanced surgical precision, including three-dimensional simulation, intraoperative navigation systems, and the advancement of minimally invasive approaches. The review evaluates the ongoing debate between anatomical versus non-anatomical resection and examines the emerging role of robotic surgery. In liver transplantation, expanded criteria beyond the Milan criteria show promising outcomes, while the integration of novel biomarkers and imaging techniques improves patient selection. The role of preoperative and adjuvant therapies is increasingly important, with recent trials demonstrating the potential of immune checkpoint inhibitors combined with anti-VEGF agents in both settings. Despite these advances, postoperative recurrence remains a significant challenge. The review concludes that successful HCC treatment requires a personalized approach, integrating surgical expertise with emerging technologies and systemic therapies while considering individual patient factors and regional variations in practice patterns.
肝细胞癌（HCC）仍然是一项重大的全球健康挑战，每年有超过80万例新病例被诊断出来。这篇综述探讨了HCC治疗中当前的手术方法和新兴的多学科策略。虽然传统的手术标准，如巴塞罗那临床肝癌（BCLC）分期系统，一直相对保守，但来自亚洲大型中心的最新证据支持在精心挑选的患者中采用更积极的手术方法。该综述讨论了选择标准的演变，包括新的“边缘可切除HCC”分类系统，它为手术决策提供了更明确的指导。技术创新显著提高了手术精度，包括三维模拟、术中导航系统以及微创方法的进步。该综述评估了解剖性切除与非解剖性切除之间持续的争论，并探讨了机器人手术的新兴作用。在肝移植方面，超出米兰标准的扩大标准显示出有前景的结果，而新型生物标志物和成像技术的整合改善了患者选择。术前和辅助治疗的作用越来越重要，最近的试验表明免疫检查点抑制剂与抗VEGF药物在这两种情况下联合使用的潜力。尽管有这些进展，但术后复发仍然是一个重大挑战。该综述得出结论，成功的HCC治疗需要个性化方法，将手术专业知识与新兴技术和全身治疗相结合，同时考虑个体患者因素和实践模式的地区差异。
