The Shifting Sands of Liver Cancer in a Post-Epidemic Era
A comprehensive review in Liver International details the evolving landscape of hepatocellular carcinoma (HCC) in Egypt following the nation’s successful mass elimination of hepatitis C virus (HCV). While the historic HCV epidemic, driven by past medical campaigns, created one of the world’s highest HCC burdens, the widespread use of direct-acting antivirals has dramatically reduced the viral reservoir. This public health triumph is now revealing a new aetiological profile, with metabolic dysfunction-associated steatotic liver disease (MASLD) emerging as a leading risk factor alongside persistent contributions from hepatitis B virus. In response, Egyptian clinical pathways are adapting, implementing risk-stratified surveillance protocols with more frequent ultrasonography and biomarker checks for high-risk groups, and structuring treatment pathways to prioritize curative surgical and locoregional options for early-stage disease while integrating modern systemic therapies for advanced cases.
Study Significance: For surgical oncologists and hepatobiliary surgeons, this epidemiological shift underscores the critical need for updated preoperative assessment and patient selection criteria. As the patient population transitions from viral to metabolic liver disease, surgical risk profiles, postoperative complication rates, and long-term oncological outcomes may change, requiring adjustments in perioperative care and enhanced recovery protocols. This evolution highlights the importance of multidisciplinary collaboration between surgery, hepatology, and oncology to refine surveillance strategies and optimize surgical outcomes in a changing disease landscape.
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