J.Jpn. Surg. Soc.. 122(2): 140-146, 2021

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Feature topic

HEPATOCELLULAR CARCINOMA

In some guidelines, surgery is not recommended for patients with advanced hepatocellular carcinoma (HCC) when they have poor prognostic factors such as vascular invasion, extrahepatic metastasis, and/or impossibility of curative resection because their prognosis is poor even with surgical treatment. The tumors in these patients are considered oncologically unresectable. Although Japanese guidelines recommend surgery in patients with portal vein tumor thrombus limited to the first-order branch, it is not recommended in those with extrahepatic metastasis or those who cannot undergo curative resection. The efficacy of various multidisciplinary therapies, which combine preoperative nonsurgical treatment and surgery, has been validated to improve the prognosis of patients with technically and/or oncologically unresectable HCC. However, the efficacy of preoperative treatment with conventional transarterial chemoembolization and systemic therapy using sorafenib was limited. In recent years, high response rates to new systemic therapies, such as lenvatinib or the combination of atezolizumab and bevacizumab, have been reported. Preoperative treatment using these new systemic therapies is expected to improve the prognosis of patients with unresectable HCC. The LENS-HCC clinical trial evaluating the efficacy of lenvatinib with the intent of conversion to resection has been underway since July 2019.

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