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Sullivan et al. Hepatoma Res 2018;4:68 Hepatoma Research
DOI: 10.20517/2394-5079.2018.95

Review Open Access

Minimally invasive therapies for hepatocellular
carcinoma: narrowing the gaps

1
Kevin M. Sullivan , Raymond S. Yeung 1,2
1 Department of Surgery, University of Washington, Seattle, WA 98195, USA.
2 Center for Advanced Minimally Invasive Liver Oncologic Therapies (CAMILOT), University of Washington, Seattle, WA 98195, USA.
Correspondence to: Dr. Raymond S. Yeung, Department of Surgery, University of Washington, 1959 NE Pacific, Seattle, WA 98195, USA.
E-mail: ryeung@uw.edu
How to cite this article: Sullivan KM, Yeung RS. Minimally invasive therapies for hepatocellular carcinoma: narrowing the gaps.
Hepatoma Res 2018;4:68. http://dx.doi.org/10.20517/2394-5079.2018.95
Received: 21 Aug 2018 First Decision: 9 Oct 2018 Revised: 18 Oct 2018 Accepted: 18 Oct 2018 Published: 25 Oct 2018

Science Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Zhong-Yu Guo

Abstract
With increasing awareness of the HCC epidemic around the globe, early diagnosis of tumors provides a greater
opportunity to benefit patients from liver-directed treatments including surgical resection, ablation, catheter-based
therapies and external beam radiation. Development of new approaches and refinement of existing techniques
have improved our capabilities to provide efficacious and safe means of local disease control. The choice of
treatment for individual patients hinges heavily on factors related to the tumor, underlying hepatic function, and
existing co-morbidities. Recent advances in minimally invasive therapies across all disciplines have augmented our
ability to eradicate the tumor while preserving liver parenchyma. In this review, we discuss and summarize current
minimally invasive options that are available to treat HCCs that are confirmed to the liver, especially in their early
stages. Emerging evidence suggest that resection, ablation and radiation can all provide excellent local control,
and this opens more options for patients to best suit their needs.

Keywords: Resection, ablation, chemoembolization, radioembolization, Yttrium-90, radiation, laparoscopic, robotic

INTRODUCTION
Hepatocellular carcinoma (HCC) has the sixth highest cancer incidence and is the fourth most common
[1]
cause of cancer-related mortality worldwide . In the United States, the average annual percent change in
the cancer-related death rate for HCC increased 2.8% from 2003 to 2012, compared to a decrease in the
average annual percent change in cancer-related death for the majority of the other top causes of cancer-
[2]
related death . Common causes of HCC are cirrhosis due to hepatitis B virus, hepatitis C virus (HCV), or
alcoholic hepatitis, with less common etiologies including hereditary diseases such as hemochromatosis or

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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