A questionnaire survey to explore the current treatment policies adopted for patients with advanced hepatocellular carcinoma at board‐certified HPB training institutions in Japan: A JSHBPS project study 2023, Part 1

Abstract Purpose To clarify the views of expert hepatobiliary surgeons on the management of advanced hepatocellular carcinoma (HCC) in real‐world clinical practice. Methods A questionnaire survey was conducted of Japanese board‐certified HPB training centers. Results A total of 100 centers responded to the survey. For solitary large (>10 cm) lesions, 77% of the respondents selected upfront surgery, while an increasing number of respondents selected combined therapy with atezolizumab + bevacizumab as the treatment of first choice as the number of lesions increased. In regard to the treatment of patients with vascular invasion, the proportion of respondents who selected systemic therapy with the intent to “potential conversion” surgery increased according to the extent of tumor thrombosis, while only a limited number of respondents excluded these groups of patients from potential surgical indications. As for the initial treatment for extrahepatic spread, consideration of systemic conversion therapy was the most commonly selected option, while upfront surgery was frequently selected for right adrenal metastasis (50%) and solitary hilar node involvement (35%). Conclusions The present survey clarified the current clinical approaches for the treatment of advanced HCC at HPB training centers. Future analysis, including survival outcomes, would offer important insights into the optimal management of advanced HCC.