ABSTRACT
There is some discrepancy in the literature regarding the definition of small hepatocellular carcinoma (HCC). In surgical practice, 5 cm has emerged as the most suitable cut-off between small and large HCCs when a surgical approach is contemplated, 1,2 despite the fact that transplant surgeons consider 3 cm as the upper limit of small HCCs. 3 Although ablation by thermal injury and ethanol injection has gained a wide success, at present partial liver resection and liver transplantation still offer the best chance for cure. Neither adjuvant therapy with chemotherapy nor preoperative chemoembolization has been shown to be of any benefit in reducing the risk of recurrence or improving survival. 4 Despite the growing role and the encouraging results of liver transplantation in the treatment of HCC in cirrhosis, and in view of the shortage of organs, partial liver resection remains the therapy of choice. Over the last two decades, increased screening of patients with chronic liver disease has led to a rise in the number of resections of HCC in cirrhosis. In specialized centres, noteworthy progress in operative techniques and improvements in the surgical care of patients with liver cirrhosis have been achieved. However, while the risk of hepatic resection in cirrhosis has decreased dramatically during the last 15 years, the operation remains an arduous one in some cases. Nevertheless, it is imperative that we demystify this procedure, which can be relatively safe provided that some rules are respected. In other words, careful and precise preoperative evaluation is paramount in order to select those patients who might benefit from liver resection or liver transplantation.
