Surgical Treatment for Hepatocellular Carcinoma in the Era of Multiple Staging and Algorithm

A plethora of staging systems for hepatocellular carcinoma (HCC) has existed, as the management for HCC is made complex by the interplay of tumor characteristics and the health and underlying functions of both the patient and the liver. The majority of patients with HCC have nonsurgical HCC. The Barcelona Clinic Liver Cancer (BCLC) classification has been regarded as the optimal staging system and treatment algorithm for HCC. However, even in patients with intermediate or advanced stage in BCLC classification, who had not been originally recommended to undergo surgery, some could benefit in terms of long-term survival by surgical treatments. An expert panel on HCC has stated that the American Joint Committee on Cancer staging system, whose predictive power on the outcome have been improved by continuous amendments, should be applied for patients undergoing surgery. Herein, we review the recent staging system focusing on patients with HCC undergoing surgery.   This review contains 5 figures, 3 tables and 34 references Key Words: American Joint Committee on Cancer, Barcelona Clinic Liver Cancer, hepatic resection, hepatocellular carcinoma, orthotopic liver transplantation