The Need to Correct the Indication for Liver Resection in Cirrhotic Patients with Hepatocellular Carcinoma: Reply

Excerpt

We are grateful to Di Carlo et al. [1] for their interest in and comments concerning the need to correct the indication for liver resection (LR) in cirrhotic patients with hepatocellular carcinoma (HCC), which we described in our recent article [2]. As we know, LR remains without doubt the main curative treatment for patients with HCC [3], and the criteria for LR proposed by Makuuchi et al. [4] have subsequently been widely utilized for assessing the extent of LR. However, we believe that the majority of centers worldwide might have their own modified criteria for LR based on the frequency of liver surgery at the center and the experience of the surgeons, and also on the facilities available at the respective institute [5‐8]. Therefore, Makuuchi’s algorithm should, in principle, be considered only a guideline and not applicable to every patient. Each individual should be thoroughly assessed as to whether he/she is suitable to undergo LR for HCC. Theoretically, factors, including the size, number, and location of tumors; hepatic functional reserve; and the patient’s physical status, should be taken into consideration when evaluating the suitability of LR. …