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Zhong et al. Hepatoma Res 2019;5:18 Hepatoma Research
DOI: 10.20517/2394-5079.2019.01

Editorial Open Access

Controversies of hepatectomy and adjuvant therapy
for hepatocellular carcinoma: moving forward

Jian-Hong Zhong , Bang-De Xiang 1,2
1,2
1 Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China.
2 Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning 530021, China.

Correspondence to: Dr. Bang-De Xiang, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University,
He Di Rd. #71, Nanning 530021, China. E-mail: xiangbangde@163.com

How to cite this article: Zhong JH, Xiang BD. Controversies of hepatectomy and adjuvant therapy for hepatocellular carcinoma: moving
forward. Hepatoma Res 2019;5:18. http://dx.doi.org/10.20517/2394-5079.2019.01

Received: 2 Jan 2019 First Decision: 14 Jan 2019 Revised: 22 Mar 2019 Accepted: 23 Mar 2019 Published: 6 Jun 2019

Science Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Due to the prevelence of hepatitis B virus (HBV) and hepatitis C virus (HCV), occurrence of hepatocellular
[1]
carcinoma (HCC) is increasing in many countries/regions, including China . HBV and HCV infections,
alcohol consumption, non-alcoholic steatohepatitis cirrhosis, or obesity pandemic are risk factors of HCC
development. A recent survey study found about 70% patients with HCC are diagnosed as intermediate or
[2]
advanced disease because of the lack of significant syndrome in their early stage . Main treatments of HCC
include hepatectomy, liver transplantation, ablation (radiofrequency, microwave, cryoablation), transarterial
chemoembolization, radiotherapy, chemotherapy, target therapy, and so on. Among these treatments, only
hepatectomy, liver transplantation, and ablation are curative treatments, with a 70% 5-year overall survival
(OS) for early stage HCC. Hepatectomy is not recommended by Western official guidelines for intermediate
and advanced stage HCC. However, Eastern official guidelines and many liver centres recommend
hepatectomy for such patients who are with preserved liver function. Tumor recurrence, which occurs in
[3]
70% within 5 years after hepatectomy, is a major cause of death after hepatectomy . This recurrence can be
true recurrence relating to primary tumor (intrahepatic metastases), which occurs less than two years, or it
can be due to the development of de novo tumors relating to liver disease (such as HBV/HCV and cirrhosis),
which occurs at least two years later. Even so, none Western official guidelines recommend any effective
adjuvant therapy to prevent HCC recurrence.

Therefore, there are at least three controversies in the field of HCC treatment between literature evidence
and official guidelines. Namely:
1.
2.
3. Should postoperative HCC patients receive adjuvant treatments?

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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