Hepatectomy includes both radical and palliative resection.
Radical liver cancer surgery
It is generally accepted that the criteria for radical resection of hepatocellular carcinoma can be classified into 3 levels based on the degree of surgical refinement.
- Grade I: Complete resection of the tumor seen by the naked eye, with no residual cancer at the cut edge.
- Grade II criteria: 4 conditions are added to the grade I criteria.
- No more than 2 tumors;
- No portal trunk and primary branches, common hepatic duct and primary branches, hepatic vein trunk and inferior vena cava thrombus;
- No hilar lymph nodes.
- No hilar lymph node metastases;
- No extrahepatic metastases.
- No extrahepatic metastases.
- Grade III criteria: On the basis of grade II criteria, add the condition of negative postoperative follow-up results, i.e., preoperative serum alpha fetal protein (AFP) elevated, AFP decreased to normal within 2 months after surgery; no tumor residue was seen on imaging.
Palliative liver cancer surgery
Any hepatectomy that does not meet the criteria for radical resection of hepatocellular carcinoma grade 3 is called palliative hepatocellular carcinoma surgery.
For example, liver tumor resection and portal vein embolization in a patient with hepatocellular carcinoma with portal vein trunk carcinoma emboli is palliative liver cancer surgery, even if the carcinoma emboli visible to the naked eye are removed during surgery.