Table 2. . Synopsis of principal guidelines recommendations and contraindications for liver resection in patients with hepatocellular carcinoma.
| Organization | Extrahepatic metastasis | Vascular invasion | Liver function | Tumor extension | Adjuvant therapies |
|---|---|---|---|---|---|
| EASL-EORTC | Contraindication | Contraindication | Child-Pugh A, normal bilirubin with either hepatic venous pressure gradient 10 mmHg or platelet count 100,000/mmc | Solitary tumor | Not recommended. Further evidence required to be adopted |
| NCCN | Contraindication | Contraindication, but major vascular invasion can be considered | Child-Pugh A (B in highly selected cases) Adequate FLR |
Solitary tumor. Multinodular is controversial but can be considered | Not recommended |
| APASL | Contraindication | Not main portal vein, but major intrahepatic venous branches can be considered | ‘Satisfactory liver function reserve’ | Solitary or multifocal tumor | Not recommended |
| JSH | Contraindication | Third or fourth branch of portal venous invasion is sometimes admitted | Child-Pugh A or B | First choice for patients with up to three nodules. Can be considered for patients with more nodules | Not recommended |
| AISF | Contraindication | Contraindication. Peripheral portal invasion requires comparative clinical studies | Similar to EASL, but Child-Pugh B, hyperbilirubinemia, portal hypertension can be evaluated by a multidisciplinary team with great expertise | Solitary tumor. Multinodular can be evaluated by a multidisciplinary team with great expertise | Not recommended. Should be tested in prospective studies |
AISF: Italian Association for the Study of the Liver; APASL: Asian-Pacific Association for the Study of the Liver; EASL-EORTC: European Association for Study of Liver-European Organization for Research and Treatment of Cancer; FLR: Future liver remnant; JSH: Japanese Society of Heptology; NCCN: National Comprehensive Cancer Network.