a) Surgical resection is the treatment of choice for noncirrhotic patients who have HCC. However, this constitutes only 5% of Hepatocellular carcinoma patients in the United States and up to 40% of those in Asian countries.Overall 5-year survival rates for patients with Hepatocellular carcinoma treated with resection is 40% to 50%, with recurrence rates of around 40% to 50%. The most important predictors of recurrence are microvascular invasion and multinodular tumors. Repeathepatic resection for recurrence has been demonstrated to be safe and effective in selected lesions.
b) Orthotopic liver transplantation (OLT) is theoretically the best treatment option for Hepatocellular carcinoma because it removes the tumor together with the entire diseased liver, thus eliminating the risk of de novo or recurrent disease. Initial results of OLT for Hepatocellular carcinoma were dismal.
c) Local ablation is the best treatment option for patients who have early-stage Hepatocellular carcinoma and are not suitable for resection or OLT. In addition, these therapies may serve as bridges to OLT for those on the transplant waiting list. Indeed, downstaging tumors improves survival of Hepatocellular carcinoma patients who subsequently undergo OLT.
d) Ablation may be accomplished by chemical (100% ethanol) or physical (radiofrequency, cryoablation) techniques. Percutaneous ethanol injection has been shown to be effective for small tumors; the necrosis rate for Hepatocellular carcinoma less than 2 cm is 90% to 100%, but declines to 50% in larger tumors. However, multiple sessions may be required to achieve complete necrosis of each tumor. This technique is rarely used in the United States today
e) Radiofrequency ablation (RFA) has emerged as the procedure of choice in most centers. A needle electrode is placed into the tumor, destroying tissue by heating it to temperatures of 60°C to 100°C. RFA may be performed intraoperatively or percutaneously under imaging guidance. Extendable electrodes within the needle allow larger tumors to be ablated compared to ethanol injection, as well as allow the specific volume of tissue for ablation to be varied.