The Impact of Anaesthesia on Inflammation and NETosis in Hepatocellular Carcinoma Resection

HCC is the most common type of primary liver cancer. It predominantly develops in individuals with chronic liver diseases, such as cirrhosis resulting from hepatitis B or C.

According to the International Agency for Research on Cancer, approximately 826,000 new cases of HCC were recorded globally in 2018, accounting for roughly 4.5% of all malignancies. Projections indicated that by 2025, over one million individuals would be affected by HCC annually. The incidence of HCC varies significantly by region, with the highest rates observed in East and Southeast Asia, and the lowest rates reported in Northern Europe and North America.

Therapeutic Landscape & Thermal Ablation Surgical resection remains the first-line treatment for early-stage HCC. While some studies report that only 20%-25% of HCC patients are candidates for surgical intervention, up to 60% of patients in developed countries undergo surgery, RFA, or microwave ablation (MWA). This variation depends heavily on the patient's performance status, comorbidities, and the clinical stage of the tumor. Furthermore, due to donor shortages and high associated costs, the proportion of HCC patients undergoing liver transplantation remains exceedingly low.

For patients with tumors under 3 cm in diameter, RFA demonstrates no significant difference in long-term survival compared to surgical resection and liver transplantation. Moreover, it offers distinct clinical advantages, including a lower risk of complications, reduced costs, superior preservation of functional hepatic volume, and shorter hospital stays. Consequently, RFA has been established as a core local curative technique for HCC, whereas therapies such as tyrosine kinase inhibitors and transarterial chemoembolization (TACE) are typically reserved for palliative management.

RFA has become the standard of care for unresectable HCC and has proven highly competitive with surgery for single nodules smaller than 3 cm. However, a high incidence of local and distant recurrence persists, which correlates directly with the ablation technique and tumor volume. Among newer ablative modalities, microwave ablation has shown promising results by increasing the zone of coagulation necrosis and reducing distant metastasis rates. Nonetheless, a comprehensive meta-analysis of these techniques conducted by Facciorusso et al. in 2020 failed to demonstrate a statistically significant difference between them.