Expanded Criteria for Resection: Are Current Guidelines Too Conservative?

The surgical treatment of hepatocellular carcinoma (HCC) relies on the guidelines edited by the American (AASLD) and Europe (EASL) societies, according to the evidence-based Barcelona clinic liver cancer (BCLC) staging system. One drawback of the BCLC system is that it is not acknowledged by surgeons. For patients with locally advanced HCC (BCLC stage B and C) treatments such as transarterial chemoembolization (TACE) and Sorafenib are preferred over surgery as they have shown survival benefits in nonrandomized series. While the BCLC management schema has been adopted into hepatology-driven Western guidelines, algorithms from Asian countries are advocating to extend the criteria for surgery in HCC. In this chapter, we will assess if the guidelines for resection are too restrictive in the management of HCC.