Multidisciplinary management of recurrent and metastatic hepatocellular carcinoma after resection: an international expert consensus

Hepatocellular carcinoma (HCC) is the sixth-most common cancer and the third leading cause of cancer-related death in the world, with more than 50% of new cases being diagnosed in China (1). According to the latest data from China (2), HCC is the fourth-most common malignancy and the third leading cause of mortality. Surgical treatment, including hepatectomy and liver transplantation, is the most commonly used approach to improve the survival of patients. However, 40–70% patients eventually suffer from postoperative recurrence within 5 years (3). Nevertheless, there is an opportunity to improve patient prognosis if investigators can recognize the importance of a standardized perioperative management and study it in clinical and pre-clinical settings. Preoperative evaluation, recurrence prediction, surgical technique, postoperative surveillance and treatment should be standardized for HCC management. A multidisciplinary team (MDT) could thus maximize the advantages of different disciplines and benefits to patients. Based on our own experience and published studies from other researchers, for the first time, we have reached a consensus for the management of recurrence and metastasis after HCC resection. A draft consensus was written by the MDT of West China Hospital. During the preparation of the consensus, all important aspects of MDT management of HCC were discussed with other professors specializing in liver surgery, hepatic tumor, hepatitis and hepatic imaging from West China Hospital. After that, more experts from renowned hospitals in other regions of China joined to update the consensus. We also invited experts from Italy, Korea, Japan and the USA to review and improve the consensus, thus formulating an international consensus. With emerging evidence, this initial version of the consensus needs to be updated and improved in the future