Hepatectomy for Stage B and Stage C Hepatocellular Carcinoma in the Barcelona Clinic Liver Cancer Classification

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Abstract
Hepatocellular carcinoma (HCC) is usually associated with liver cirrhosis and is the principal cause of death among patients with cirrhosis.1 Apart from liver transplantation that may cure both conditions, treatment of HCC and cirrhosis is complex because of the need to be oncologically radical but simultaneously conservative. In this sense, hepatectomy is considered an invasive approach and has a marginal role in the treatment of HCC.2,3 According to the Barcelona Clinic Liver Cancer (BCLC) classification,4 hepatic resection should be performed only in patients with small single tumors without signs of portal hypertension or hyperbilirubinemia. Patients with multiple, large, or vascular invasive HCC should receive palliation or no treatment. However, surgical morbidity and mortality may approach 0% in expert hands,5-7 and liver resection could offer effective treatment to patients with multiple, large, or vascular invasive HCC.8-11