到目前为止，手术仍然是肝癌根治性治疗的主要手段。以外科治疗为主的综合治疗，日益受到重视。其含义主要包括3个方面：（1）可切除肝癌在术前、术后行综合治疗，以减少肝癌复发和转移；（2）不可手术切除肝癌病人的综合治疗，目的是二期切除；（3）肝移植前辅助治疗，目的是控制肿瘤进展，增长等候供肝的时间。由于国内外已发表的研究在数量和质量上均存在局限性，所有综合治疗的报道均是小样本、非随机对照研究，无法给临床选择提供可靠的证据。尚有待开展大样本、高质量的多中心随机对照研究，并通过长期随访评估其远期疗效。由于没有足够的证据作治疗的规范化，临床医生可以根据目前仅有的证据，结合病人的具体情况来综合评估病情，选择最佳的治疗方式。新的治疗只应通过恰当设计的研究作测试其疗效。综合治疗补充手术治疗的不足，增加外科手术切除机会与减少术后复发转移等方向的研究，是今后肝癌外科领域的重要任务。

Roles of surgery in the multidisciplinary treatment of hepatocellular carcinoma        LAI ECH, LAU SHY, LAU WY. Faculty of Medicine, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, P.R. China
Corresponding author：LAU WY，E-mail：josephlau@cuhk.edu.hk
Abstract    Liver resection is still the best treatment for hepatocellular carcinoma (HCC) aiming at cure. The important roles of surgery in the multidisciplinary treatment of HCC have increasingly been recognized. They include 3 aspects as following (1) neoadjuvant/adjuvant therapy to reduce the incidence of postoperative tumour recurrence or metastases for resectable HCC; (2) tumour downstaging followed by salvage liver resection for initially unresectable HCC; (3) adjuvant therapy for patients with HCC waiting for liver transplantation to control the rate of tumour growth and to prolong the waiting time for a donor liver to become available. There are limitations on the data from published medical literature on multidisciplinary treatment of HCC. All the reports are small in sample sizes and they are non-randomized studies. Thus, there is not enough medical evidence for clinical practice to be based on. There is an urgent need for high quality randomized studies with prolonged follow-up to be carried out. Until that time, clinicians can only base on the limited available medical evidence to decide on the best treatment for their patients. Any new treatment for HCC should now be evaluated properly with a well-designed clinical study. Future clinical studies on HCC should center on multidisciplinary treatment to improve on the results of surgery, on procedures to increase on tumour resectability, and on measures to reduce postoperative tumour recurrence or metastases.