Surgical removal of the tumor (Liver Resection):
Surgical treatment (resection) is only possible in 10-20% of patients in HCC, since patients usually present at an advanced stage.
Although it is recommended that patients with a tumor diameter less than 5 cm be evaluated for surgical treatment, the generally accepted view is that the tumor diameter is 2 cm or less for resection.
For resection, the tumor must be limited to the liver, no distant metastases, no thrombosis in the portal or hepatic veins, and adequate liver capacity. Because of the risk of underlying cirrhosis and decompensation of the remaining liver after resection in most patients with HCC, careful evaluation is required for resection before surgery.
The minimal liver size that should remain after resection should be 25% of the liver in the presence of normal liver and 50% of the liver in cirrhotic liver. Unfortunately, the incidence of tumor recurrence (recurrence) after resection in patients with cirrhosis is around 50-70% within 5 years.
This is mostly due to the spread of the primary tumor in the liver (70-80%), and a small part to the newly formed tumors (de novo tumor) (30-40%). Only 30% of patients survive for 5 years after resection.