ABSTRACT

Hepatocellular carcinoma (HCC) is a significant cause of morbidity and mortality with 500.000 new cases each year. In this paper, we reviewed the risk factors, epidemiology, clinical course, diagnosis and treatment of HCC in the light of the recent literature. The most important risk factors are cirrhosis related to hepatitis B and C viruses and nonalcoholic fatty liver disease. Somatic mutations in the p53 tumor suppressor gene, retinoblastoma (Rb) gene and AXINI tumor suppressor gene are involved. Alphafetoprotein, one of the tumor markers, is elevated. The mass is usually detected by radiological investigations during follow-up. Ultrasound, computed tomography, and magnetic resonance imaging are used for the initial diagnosis. Routine biopsy is not necessary. The patients are evaluated according the Child Pugh classification, model of end-stage liver disease (MELD) score, Barcelona clinic liver cancer score (BCLC), and Milan criteria for HCC. If surgical intervention is decided, preoperative evaluation and preparation of the patient is done adequately. The patient is evaluated for clinical outcomes, volume of the future liver remnant, hepatic segment volumes and vascular anatomy. An appropriate treatment modality (R0 resection, transplantation, radiofrequency ablation, transarterial chemoembolization, or portal vein embolization) should be chosen. The most significant postoperative complication is liver failure. These operations are performed in the department of surgery at Haseki Training and Research Hospital for 4 years. Among 25 cases including 7 cases of right or left hepatectomy, the rate of mortality and morbidity is 0% and 16%, respectively.