Novel molecular therapies using targeted drugs and immune checkpoint inhibitors for advanced hepatocellular carcinoma have been evolving. Sorafenib and lenvatinib have been commonly used as first-line therapy, followed by recent atezolizumab plus bevacizumab. The median survival time has gradually improved to over 1.5 years. The complete radiological response does not always mean a complete pathological response and a permanent cure of disease. To resolve this, conversion surgery has developed. Lenvatinib is the most suitable drug due to its high response rate. A recent large cohort study using lenvatinib had a conversion rate of 8.4% and an estimated disease-specific survival time of >80% at three years. Conversion to curative resection was an independent predictive factor for better disease-specific survival compared with lenvatinib monotherapy. In conclusion, conversion surgery following molecular therapy is a promising treatment strategy for prolonging long-term outcomes. We should discuss promising drugs and the timing for conversion surgery.
Keywords: Conversion hepatectomy; hepatocellular carcinoma; lenvatinib; molecular therapy; review; surgery.
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