This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lau, W. Y. Articles by Lai, E. C. H. Search for Related Content PubMed Articles by Lau, W. Y. Articles by Lai, E. C. H.

Salvage Surgery Following Downstaging of Unresectable Hepatocellular Carcinoma—A Strategy to Increase Resectability

Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China

Correspondence: Address correspondence and reprint requests to: Wan Yee Lau, MD, FACS, FRCS, FRACS(Hon); E-mail: josephlau{at}cuhk.edu.hk

Background: Surgical resection with complete extirpation of the tumor gives the best chance of a cure for patients with hepatocellular carcinoma (HCC). However, the resectability of HCC at the time of diagnosis is low (10–30%). This article reviews the use of salvage surgery following tumor downstaging to treat unresectable HCC.

Materials and Methods: A Medline search was undertaken from 1966 to 2005 to identify articles using the keywords "liver neoplasm," "hepatocellular carcinoma," "tumor down-staging," and "unresectable." Additional papers were identified by a manual search of the references from the key articles.

Results: Eight to eighteen percent of patients with unresectable HCC responded well enough to the initial palliative treatment to downstage HCC to allow salvage surgical resection. The reported five-year survival rate after salvage surgery following tumor downstaging varied from 24.9 to 57%.

Conclusions: Although it is still unknown whether the outcome of salvage surgery following tumor downstaging is comparable to those of resectable tumors after primary resection, one clear message is that salvage surgery following tumor downstaging gives good long-term results and the possibility of a cure in a proportion of patients with unresectable HCC. The role of salvage surgery after tumor downstaging in improving disease-free and overall survival in patients with unresectable HCC should be investigated further by prospective randomized controlled trials.

Key Words: Hepatocellular carcinoma • Tumor downstaging • Hepatectomy • Therapeutic embolization • Salvage surgery