Is It a Time to Modify the BCLC Guidelines in Terms of the Role of Surgery?

Excerpt

Dr. Liu and coworkers in Taichung [1] have posed an important question regarding the surgical indications for hepatocellular carcinoma (HCC) in patients with gastroesophageal varices, which is a contraindication for surgery in the BCLC/EASL/AASLD guidelines. Since their original publication in 1999 [2], these guidelines have been repeatedly reported in prestigious journals [3], and the total number of citations for these publications has already exceeded 10,000. According to the guidelines, patients with portal hypertension (PH), defined by the presence of esophagogastric varices, splenomegaly, a platelet count of less than 100,000, or an elevated hepatic venous pressure gradient (HVPG), are clearly not candidates for liver resection. However, this recommendation was based solely on a small retrospective cohort study conducted in Spain with only 77 resected patients and published in 1999 [4]. The targeted long-term outcome for BCLC-A patients was set at a 5-year overall survival (OS) rate of between 50 and 70 %, and the outcome of patients with PH did not exceed 50 % in that particular study. …