1.2.1 Surgical Treatment of Liver Cancer

1.2.1 Surgical Treatment of Liver Cancer

Surgical resection is an important method for treating small liver cancers with a diameter ≤3 cm, as it can completely remove the lesion and enable long-term survival for patients. Surgical approaches mainly include regular hepatic lobectomy, segmental hepatectomy or local excision, and liver transplantation.

Zheng Xiaofeng et al. conducted a retrospective analysis of data from 80 patients who underwent surgery between 2000 and 2005, revealing that the 5-year survival rate after surgery was 27.5%; for patients who underwent re-resection after liver cancer recurrence, the 5-year survival rate was only 12.5%. Lu Li et al. performed partial hepatectomy on a total of 131 liver cancer patients over a ten-year period, with 129 surviving patients receiving postoperative follow-up. Their 1-, 3-, and 5-year survival rates were 73%, 55%, and 35%, respectively. Yuan Yunfei et al. analyzed case data from 173 giant liver cancer patients who underwent surgery, finding that their cumulative 3-, 5-, and 10-year survival rates were 31.9%, 21.8%, and 8.3%, respectively. These results demonstrate that hepatectomy can significantly improve the survival rate of liver cancer patients. Mastering the indications for hepatectomy and strictly controlling intraoperative bleeding during liver cancer resection are crucial for reducing postoperative complications such as intra-abdominal hemorrhage and hepatic renal failure, thereby ensuring the therapeutic effectiveness of the surgery.

The application of liver transplantation in the treatment of liver cancer has undergone a tortuous process. Since Starzl successfully performed human liver transplantation in 1963 until the 1990s, people gradually recognized the importance of liver transplantation in treating liver cancer. Liver transplantation is suitable for small liver cancers accompanied by severe cirrhosis that cannot be surgically removed, and its clinical application has improved the cure rate of liver cancer. However, due to the scarcity of donor livers, transplant rejection reactions, the need for lifelong immunosuppressive medication, and high treatment costs, the clinical application of liver transplantation remains limited. Therefore, determining appropriate criteria for liver transplantation in liver cancer cases is very important. Currently, liver transplantation is developing rapidly in China, with technology becoming increasingly mature. The Chinese Society of Surgery and the Society of Hepatobiliary Surgery recommend adopting the internationally widely used Milan criteria from Italy or the UCSF criteria from the University of California, San Francisco. The Shanghai Liver Cancer Research Institute, based on China's national conditions, has proposed the Shanghai Fudan criteria.