Surgery for early stage hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide, and the curative treatment is available only for tumors detected in early stage. In a critical analysis of the therapeutic options in early stage HCC three potential curatives therapies are possible in early stage HCC: total hepatectomy with liver transplantation (LT), partial hepatectomy and radiofrequency ablation (RFA) of very small tumors. Total hepatectomy with LT has proven to be the best treatment for operable and resectable disease (BCLC 0 and A) in a cirrhotic liver, the liver resection, RFA, transarterial chemoembolization (TACE) or percutaneous injection of alcohol (PIA) can be considered for those patients with waiting list time up to six months. Partial hepatectomy as definitive therapy should be used only for patients with patients in Child-Pugh A and B without portal hypertension. In patients with inoperable but localized disease (BCLC A), the RFA or PIA can be indicated.