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BackTable / Tumor Board / Podcast / Episode #7
Surgery for HCC: What’s Its Role Today?
with Dr. John Seal, Dr. Gabe Schnickel and Dr. Sid Padia
Is surgery truly the "cure" for hepatocellular carcinoma (HCC), and when is it a viable option? In this episode, Dr. Sabeen Dhand leads a roundtable discussion with interventional radiologist Dr. Siddharth Padia and transplant/hepatobiliary surgeons Dr. John Seal and Dr. Gabriel Schnickel, delving into the complexities of surgical treatments for HCC and the evolving landscape of liver resection and transplantation.
This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.
BackTable, LLC (Producer). (2025, January 17). Ep. 7 – Surgery for HCC: What’s Its Role Today? [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Synopsis
The doctors begin by discussing how they manage patient expectations regarding both palliative and curative treatments, highlighting the risk of recurrent HCC as a new lesion. They then outline key factors that influence their recommendations for liver transplant versus resection, such as the extent of underlying liver disease, the function of the future liver remnant, body habitus, overall health, and organ availability. The surgeons also review various surgical approaches to liver resection and recent advancements in liver transplantation, including living donor transplants and the ability to refer patients for downstaging procedures.
Dr. Padia explains the original role of Y90 as a bridging treatment to downstage tumors and promote hypertrophy in the non-diseased liver segments, preparing the organ for surgical resection. However, Y90 treatment can also lead to the formation of adhesions, which may complicate future surgeries. Finally, the doctors discuss strategies to improve care coordination between community physicians and transplant centers to optimize patient outcomes.
Timestamps
00:00 - Curative vs. Palliative Treatment
04:03 - Choosing Between Transplantation and Resection
05:47 - Liver Resection Types
07:27 - Bridging Role of Y90
12:14 - Evolving Landscape of Liver Transplantation
20:59 - Patient Counseling in Minimally Invasive Procedures
28:40 - Considerations for Surgery After Y90
33:32 - Coordination Between Specialists
40:08 - Immunotherapy as a Bridge to Transplant
Resources
CME Accreditation Information:
https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf
Transcript Preview
[Dr. Sabeen Dhand]
Gabe, what would be, different types of surgical approaches as far as what are different resections for our listeners? What's a [trisegmentectomy]? What's anatomical, non-anatomical?
[Dr. Gabe Schnickel]
I think that's a great question. When I think about who should get a resection and who should get a transplant, as John was saying, you have to think about the status of the underlying liver and then how much liver remnant, what's the future remnant going to be? We think about the extent of resection. Just for definition, you have your anatomic resection. When you're taking out an actual segment of liver that is based on the vascular anatomy, if you're taking out a whole, what we might call a lobe or a hemihepatectomy.
Which would be the right hemiliver or the left hemiliver, or you're doing a triseg, as you said, which means you're doing an extended hepatectomy. You're taking out all of the right and some of the left liver. Those operations for HCC are tricky because, again, most of these patients will have some underlying liver disease. I think it's around 80%, right, of patients with HCC will have cirrhosis. Those that don't might have some baseline underlying, whether it's fatty liver disease or they have hepatitis B or whatnot.
Those are all considerations that we have to keep in mind. As John said, it's really evolved over the past couple of decades when we think about transplant and when we think about resection.
The Materials available on BackTable are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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