Hepatocellular Carcinoma — Surgical Management

A 52-year-old man with a history of hepatitis C cirrhosis (Child-Pugh Class B) presents with a 3 cm solitary hepatocellular carcinoma (HCC) in the right lobe. Liver function is preserved (bilirubin 1.8 mg/dL, INR 1.3, albumin 3.2 g/dL). He has no portal hypertension-related bleeding. Which surgical intervention offers the best long-term survival?

A 58-year-old man with cirrhosis (Child-Pugh B) secondary to hepatitis B presents with a 3 cm solitary nodule in the right lobe of the liver detected on surveillance ultrasound. Contrast-enhanced CT shows arterial phase enhancement and washout in the portal venous phase. AFP is 280 ng/mL. The patient is hemodynamically stable with preserved synthetic function (INR 1.4, albumin 3.2 g/dL). What is the most appropriate surgical management?

A 52-year-old woman with cirrhosis (Child-Pugh C, MELD 18) and HCC is referred for surgical evaluation. Imaging shows a 4 cm nodule in the left lobe with no macrovascular invasion. She has ascites controlled on diuretics, INR 1.8, albumin 2.8 g/dL, and bilirubin 2.1 mg/dL. Hepatic venography shows patent hepatic veins. What is the most appropriate management?

A 58-year-old man with cirrhosis (Child-Pugh B) secondary to hepatitis B presents with a 3 cm solitary hepatocellular carcinoma in the right lobe. CT abdomen shows no vascular invasion, no extrahepatic spread, and patent hepatic veins. His ECOG performance status is 0. Platelet count is 95,000/μL, INR 1.4, and total bilirubin 1.8 mg/dL. Which of the following is the most appropriate surgical management?

A 62-year-old woman with Child-Pugh A cirrhosis (HCV-related) undergoes surveillance ultrasound and is found to have two lesions in the liver: a 2.5 cm nodule in segment V and a 2 cm nodule in segment VIII. CT with arterial and portal venous phase imaging shows arterial enhancement and washout in both lesions, confirming HCC. There is no evidence of vascular invasion or extrahepatic metastases. She is fit for surgery (ECOG 0). What is the most appropriate surgical approach?