Pretreatment assessment of hepatocellular carcinoma: Expert consensus statement

Jean Nicolas Vauthey, Elijah Dixon, Eddie K. Abdalla, W. Scott Helton, Timothy M. Pawlik, Bachir Taouli, Antoine Brouquet, Reid B. Adams

Research output: Contribution to journalArticle

Abstract

Staging of hepatocellular carcinoma (HCC) is complex and relies on multiple factors including tumor extent and hepatic function. No single staging system is applicable to all patients with HCC. The staging of the American Joint Committee on Cancer / International Union for Cancer Control should be used to predict outcome following resection or liver transplantation. The Barcelona Clinic Liver Cancer scheme is appropriate in patients with advanced HCC not candidate for surgery. Dual phase computed tomography or magnetic resonance imaging can be used for pretreatment assessment of tumor extent but the accuracy of these methods remains poor to characterize >1 cm lesions. Assessment of tumor response should not rely only on tumor size and new imaging methods are available to evaluate response to therapy in HCC patients. Liver volumetry is part of the preoperative assessment of patients with HCC candidate for resection as it reflects liver function. Preoperative portal vein embolization is indicated in patients with small future liver remnant (≤ 20% in normal liver; ≤ 40% in fibrotic or cirrhotic liver). Tumor size is not a contraindication to liver resection. Liver resection can be proposed in selected patients with multifocal HCC. Besides tumor extent, surgical resection of HCC may be performed in selected patients with chronic liver disease.

Original languageEnglish (US)
Pages (from-to)289-299
Number of pages11
JournalHPB
Volume12
Issue number5
DOIs
StatePublished - Jun 2010

Keywords

  • Chemoembolization
  • Chemotherapy
  • Consensus conference
  • Hepatocellular cancer
  • Hepatoma
  • Liver function
  • Portal vein embolisation
  • Radiotherapy
  • Staging
  • Surgery

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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  • Cite this

    Vauthey, J. N., Dixon, E., Abdalla, E. K., Helton, W. S., Pawlik, T. M., Taouli, B., Brouquet, A., & Adams, R. B. (2010). Pretreatment assessment of hepatocellular carcinoma: Expert consensus statement. HPB, 12(5), 289-299. https://doi.org/10.1111/j.1477-2574.2010.00181.x