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Invited Commentary
September 2016

Decision Tree for Liver Resection for Hepatocellular Carcinoma

Author Affiliations
  • 1Washington University, St Louis, Missouri
JAMA Surg. 2016;151(9):853-854. doi:10.1001/jamasurg.2016.1149

The incidence of hepatocellular carcinoma in the United States has grown steadily during the past 2 decades and the associated mortality has increased proportionally.1 In 2012, there were an estimated 30 000 new cases of liver cancer and 24 000 liver cancer–associated deaths.2 Underlying liver disease associated with hepatitis, autoimmune disorders, alcoholic cirrhosis, or nonalcoholic fatty liver disease has become the major risk factor for hepatocellular carcinoma in the United States.3 In fact, liver dysfunction in some form is found in upwards of 90% of patients who present with hepatocellular carcinoma.4 In these patients, curative resection is often challenging because underlying liver disease may render the functional liver remnant inadequate. An inadequate functional liver remnant can lead to the most dreaded complication following liver resection, posthepatectomy liver decompensation (LD). Given the morbidity and mortality associated with LD, appropriate preoperative risk prediction and stratification are paramount.5,6

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