Liapis I, Ziogas IA, Theocharopoulos C, Moris DP, Nydam TL, Gleisner AL, Schulick RD, Tsoulfas G. Re-evaluating surgical strategies in Barcelona Clinic Liver Cancer-B hepatocellular carcinoma. World J Hepatol 2025; 17(9): 108970 [DOI: 10.4254/wjh.v17.i9.108970]
Corresponding Author of This Article
Georgios Tsoulfas, Professor, Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, School of Medicine, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, Thessaloniki 54642, Greece. tsoulfasg@auth.gr
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Sep 27, 2025; 17(9): 108970 Published online Sep 27, 2025. doi: 10.4254/wjh.v17.i9.108970
Re-evaluating surgical strategies in Barcelona Clinic Liver Cancer-B hepatocellular carcinoma
Ioannis Liapis, Ioannis A Ziogas, Charalampos Theocharopoulos, Dimitrios P Moris, Trevor L Nydam, Ana L Gleisner, Richard D Schulick, Georgios Tsoulfas
Ioannis Liapis, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, United States
Ioannis A Ziogas, Charalampos Theocharopoulos, Trevor L Nydam, Ana L Gleisner, Richard D Schulick, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
Dimitrios P Moris, MedStar Georgetown Transplant Institute, MedStar Washington Hospital Center, Washington, WA 20007, United States
Georgios Tsoulfas, Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Author contributions: Liapis I and Ziogas IA conceptualized and designed this study; Liapis I drafted the original manuscript; Liapis I, Ziogas IA and Theocharopoulos C created the figure, table and made critical revisions; Moris DP, Nydam TL, Gleisner AL, Schilick RD and Tsouflas G also made critical revisions and have provided the final approval for submission; Liapis I, Theocharopoulos C and Ziogas IA revised the manuscript per the reviewers’ comments. All authors prepared the draft and approved the submitted version.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Georgios Tsoulfas, Professor, Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, School of Medicine, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, Thessaloniki 54642, Greece. tsoulfasg@auth.gr
Received: April 27, 2025 Revised: June 22, 2025 Accepted: September 9, 2025 Published online: September 27, 2025 Processing time: 151 Days and 21.6 Hours
Abstract
The incidence of hepatocellular carcinoma (HCC) has been steadily rising, underscoring the need for a clear, stage-specific treatment approach. The Barcelona Clinic Liver Cancer (BCLC) staging system remains the most widely used framework for classifying HCC and guiding therapy. Among its classifications, the intermediate stage (BCLC-B) encompasses a highly heterogeneous patient population, with varying degrees of tumor burden and liver function. Traditionally, transarterial chemoembolization has been the standard treatment for this stage, based on earlier evidence. However, recent studies suggest that a subset of BCLC-B patients-particularly those with localized disease-may benefit more from liver resection. This review summarizes current treatment paradigms for BCLC-B HCC, explores emerging subclassifications within this group, and highlights evolving guidelines that support the selective use of surgery in appropriately chosen patients.
Core Tip: Patients with intermediate-stage (BCLC-B) hepatocellular carcinoma (HCC) represent a highly heterogeneous group, making the establishment of uniform treatment guidelines particularly challenging. Traditionally, transarterial chemoembolization has been the standard of care for this stage. However, emerging evidence suggests that liver resection may offer superior outcomes in a carefully selected subset of patients. This literature review synthesizes current research on treatment strategies for BCLC-B HCC, with a particular emphasis on the evolving role and indications for surgical intervention.
