Informed consent for surgical treatment of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) differs from other gastrointestinal cancers due to the following characteristics: 1) a high rate of recurrence, including multicentric recurrence; 2) the treatment modality or surgical method is often selected based on liver function: and 3) the indications for medical treatment versus surgery are not clearly defined and ther is no consensus on standard indications between surgeons and hepatologists. Therefore special informed consent must be obtained from HCC patients for surgery in addition to the standard written informed consent form. Moreover, because liver surgery carries the risk of massive intraoperative hemorrhage or postoperative liver failure, sufficient time must be spent explaining the associated risks to patients before obtaining informed consent.