从"最大耐受切除"到"最大安全保留":肝细胞癌切除导向综合治疗的全周期功能管理OA

Hepatocellular carcinoma(HCC)commonly arises in the setting of chronic liver disease or cirrhosis.In resection-directed management,the focus has shifted from determining whether a tumor is technically resectable to achieving a balance among oncologic control,hepatic reserve,perioperative safety,and eligibility for future treatment after recurrence.Advances in immune checkpoint inhibitor-based antiangiogenic therapy,locoregional treatments,radiotherapy,ablation,and precision hepatectomy have enabled conversion resection or optimization of surgical conditions in selected patients with initially unresectable disease or unfavorable tumor characteristics.Nevertheless,clinically significant portal hypertension,impaired hepatic reserve,treatment-related liver injury,post-hepatectomy liver failure,and acute kidney injury remain major barriers to long-term benefit.Therefore,resection-directed management of HCC should evolve from the concept of"maximum tolerable resection"toward"maximum safe preservation".Comprehensive preoperative assessment should integrate hepatic functional reserve,future liver remnant volume,portal hypertension status,viral activity,and overall physiological fitness to define treatment intensity and safe resection boundaries.During treatment,dynamic reassessment is essential for identifying the optimal timing for conversion surgery or curative locoregional therapy.The selection of locoregional and surgical strategies should balance oncologic efficacy with preservation of liver function,while postoperative and long-term management should focus on functional recovery,recurrence surveillance,and maintenance of retreatment eligibility.Emerging technologies,including artificial intelligence,circulating tumor DNA-based minimal residual disease monitoring,and patient-derived organoid drug-sensitivity platforms,may further facilitate risk stratification and individualized decision-making.Ultimately,the goal of resection-directed comprehensive therapy for HCC extends beyond successful tumor removal to preserving liver function and sustaining long-term therapeutic opportunities throughout the disease course.