Management decisions in primary and secondary liver cancer

Management of liver neoplasia is a multidisciplinary endeavour. In the non-cirrhotic liver resectional surgery has a well-defined place in the management of primary liver tumours. In the cirrhotic liver, the approach to treatment of hepatocellular carcinoma depends on the severity of underlying liver disease and the size of the tumour. The best long term results are achieved with transplantation regardless of severity of liver failure, but the number and size of lesions is important. Liver resection can be used in any size lesion, but the extent of resection possible is dependent on the severity of liver disease. As with ablative methods, the tumour volume is an important prognostic factor. Colorectal cancer is the most common secondary liver cancer with a chance of cure following surgical resection. Surgical resection is becoming more aggressive, as more sophisticated techniques and increasing chemotherapeutic options allow removal of more advanced tumours. The role and timing of surgery, local ablation, chemotherapy and adjuvant chemotherapy are explored in the setting of both synchronous and metachronous disease. Surgical resection and the chance of cure is possible in a subset of patients with neuroendocrine liver metastases, but pharmacological and chemotherapeutic therapies are available if resection is not possible. Surgery is less applicable in non-colorectal, non-neuroendocrine tumours, but in some circumstances, it may be of benefit.