First, the choice of treatment depends on the patient’s specific situation. Specifically, (1) the general condition of the patient, i.e., whether he or she can tolerate surgery and other invasive treatments. If the patient is too old or has severe systemic disease, surgery or even interventional embolization cannot be performed. (2) The patient’s liver function status: According to the Child-Pugh classification criteria, liver function is divided into three levels, ABC, with level A being able to tolerate resection of more than half of the liver, level B only being able to tolerate resection of liver segments or irregular tumors, and level C not being able to tolerate surgery. In recent years, the assessment before surgery has become more rigorous, and the indocyanine green retention test (ICG) is mostly used to determine the liver reserve function and the residual liver volume by CT to determine the patient’s ability to tolerate surgery. (3) Tumor size, number and location: this is the key index to determine whether the tumor can be removed before surgery, usually based on CT or MRI. In addition, it is also necessary to see whether the tumor has metastasized outside the liver, especially the lung and hilar lymph nodes, and whether there is invasion of large blood vessels. Tian Mingguo, Department of Hepatobiliary Surgery, People’s Hospital of Ningxia Hui Autonomous Region
According to the above conditions, if the tumor is confined to one side of the liver, the general condition of the body is good, and the liver function is in grade A or B, surgery should be preferred, because surgery has the highest cure rate and 5-year survival rate. The surgical methods are divided into: liver transplantation, regular hemihepatectomy or segmental hepatectomy, irregular hepatectomy, simple tumor enucleation, radiofrequency treatment, donor vessel ligation, donor vessel cannulation followed by chemotherapy, etc. Among them, liver transplantation is the most effective as it can remove the tumor and solve the problem of liver cirrhosis at the same time, but it is limited to the early stage of liver cancer, and the cost is high and liver source is lacking. Regular hemihepatectomy or segmental hepatectomy is the most popular method in recent years, which causes less liver damage than irregular resection, can completely remove the lesion and its possible satellite metastases, and has less bleeding and less damage to the remaining liver tissue. However, regular surgery is technically demanding and requires fine separation and ligation of the tumor donor vessels. The hepatobiliary surgery department of Ningxia Autonomous Region Hospital has routinely adopted this method for hepatic resection, resulting in a significant decrease in surgical complications. Irregular resection, on the other hand, takes the liver tissue 1cm away from the tumor as the incision line. The operation time of this method is relatively short, but it requires blocking the liver gate, and the postoperative liver function is more impaired. If the cirrhosis is severe, the tumor is superficial and multiple, tumor enucleation is also feasible, but this method is less commonly used. Microwave or radiofrequency treatment or tumor donor vessel ligation and cannulation are feasible for those who are found to have unresectable tumors intraoperatively.
If the tumor is judged inoperable before surgery, radiofrequency treatment can be chosen. This method is performed by inserting probes into the liver tumor tissue and causing tumor solidification and necrosis by radiofrequency. This method is less invasive and causes less damage to the surrounding liver tissue, and can be treated under ultrasound localization, laparoscopic treatment or direct surgical view.
Other treatment measures currently considered effective are: interventional transhepatic artery embolization chemotherapy, anhydrous alcohol injection, cryotherapy, Chinese medicine, etc.
Finally, the treatment of hepatocellular carcinoma is increasingly advocated to be comprehensive, i.e., combined treatment by multiple methods. For example, surgical resection combined with interventional embolization therapy or radiofrequency combined with interventional embolization therapy, etc.