Remodeling the surgical approach to hepatocellular carcinoma.

Surgery for hepatocellular carcinoma has improved during the last two decades, and the improvement is mainly attributable to various innovations in liver surgery, such as establishment of the precise criteria for surgical indications, development of ultrasound-guided hepatectomy, and additional use of portal vein embolization. Operative mortality has fallen below 2% in the 1990's, and the 5-year survival rate reached, according to the results of a nationwide survey, nearly 50%. More than 90% of the hepatectomies in the authors' institution are performed without whole blood transfusion, and mean hospital stay is approximately 23 days. Moreover, no-mortality hepatectomy has been achieved since 1993.