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Chok. Hepatoma Res 2017;3:189-95                                     Hepatoma Research
           DOI: 10.20517/2394-5079.2017.33
                                                                                                  www.hrjournal.net
            Topic: Management of Huge and Advanced Hepatocellular Carcinoma                     Open Access

           Surgical strategy for huge and advanced

           hepatocellular carcinoma in Hong Kong



           Kenneth S.H. Chok

           Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong, China.
           Correspondence to: Prof. Kenneth S.H. Chok, Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, The
           University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. E-mail: kennethchok@gmail.com
           How to cite this article: Chok KSH. Surgical strategy for huge and advanced hepatocellular carcinoma in Hong Kong. Hepatoma Res 2017;3:189-95.

                                         ABSTRACT

            Article history:              In  Hong  Kong,  surgical  resection  is the  core  curative  treatment  for  huge  and  advanced
            Received: 31-07-2017          hepatocellular carcinoma (HCC). For tumors measuring 10 cm or above, major hepatectomy
            Accepted: 09-08-2017          is usually required, but a future liver remnant not large enough will preclude the operation.
            Published: 03-09-2017         Hypertrophy of future liver remnant is a way to render more patients operable, and measures
                                          include portal vein embolization and associating liver partition and portal vein ligation
            Key words:                    for staged hepatectomy. For HCC that has invaded a major vessel, en bloc resection with
            Associating liver partition and   immediate vessel reconstruction is necessary if thrombectomy would not suffice. In case of
            portal vein ligation,         bilobar involvement, radiofrequency ablation is a useful adjuctive therapy. In the treatment of
            staged hepatectomy,           extrahepatic metastasis, metastasectomy offers a cure to properly selected patients.
            hepatocellular carcinoma,
            liver resection,
            vascular resection and
            reconstruction,
            radiofrequency ablation


           INTRODUCTION                                       curative treatment. Fan et al.  reported 5-year survival
                                                                                       [3]
                                                              rates of 73% and 81% achieved by partial hepatectomy
           Hepatocellular  carcinoma (HCC)  is  the sixth most   and living donor liver transplantation respectively in
           common cancer  and is  the  most  common primary   patients within the Milan criteria.
                                     [1]
           liver malignancy worldwide.  Like hepatitis B,  it  is
           most prevalent in Asia; at the same time, most cases   In the case of huge and advanced HCC, treatment is
           of HCC on the continent are related to hepatitis B,   more limited. Only transarterial chemoembolization
           and Hong Kong is no exception.  Diagnoses of HCC   (TACE) and systemic therapy are recommended
                                        [2]
           are mostly made at a late stage as regular screening   in Western countries, [4-7]  but more aggressive
           for the disease is uncommon, and the disease often   management  is adopted in Hong Kong.  A newly
           develops  in  a  multifocal  manner  and  infiltrates  into   developed Hong Kong liver cancer (HKLC) staging is
           major vessels. As such, surgical resection is a common   now in use. In the study by Yau et al.,  surgery had
                                                                                                 [8]
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