3.3.1 Surgical Treatment of Liver Cancer

3.3.1 Surgical Treatment of Liver Cancer

Currently, surgical resection remains the preferred method for treating liver cancer, though there is still no unified standard for the extent of resection[50].

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Surgical resection can be divided into regular hepatectomy and irregular hepatectomy. Regular hepatectomy involves removing not only the diseased liver lobe or segment but also a larger portion of non-tumor liver tissue. While this approach offers more thorough treatment, it compromises the functional compensation of the remaining liver, so recently there has been a trend toward irregular hepatectomy—local resection centered on the tumor at a certain distance from the edge, while preserving the main blood supply to the residual liver[53]. In recent years, with advances in anatomy, improvements in preoperative diagnostic techniques, developments in minimally invasive surgery, and effective perioperative treatments, complications from surgical resection have markedly decreased, and postoperative recurrence and metastasis have also improved significantly. Therefore, comprehensive treatment strategies centered on surgical resection are currently the mainstay for treating liver cancer.

Liver transplantation is an important component of surgical treatment for liver cancer. In China, liver transplantation has developed rapidly, with increasingly mature techniques. Liver transplantation not only removes the tumor and eliminates the risk of intrahepatic micrometastases but also completely cures cirrhosis, avoids liver failure after hepatectomy, and effectively addresses portal hypertension and its complications, achieving radical cure. However, due to the high risk of postoperative recurrence, limited availability of donor livers, graft rejection, postoperative biliary complications, postoperative infections, lifelong immunosuppressive medication, and high costs, its clinical application is restricted. Thus, controlling recurrence and complications and establishing appropriate criteria for liver transplantation in liver cancer patients are crucial. Current liver transplantation standards mainly include the Milan Criteria, California Criteria, Pittsburgh Criteria, and in 2006, Fan Jia et al.[54] proposed the Shanghai Fudan Criteria, which, based on China's national conditions, aims to improve quality of life, avoid waste of donor livers and economic resources, and make liver transplantation one of the important methods for treating liver cancer.