It is beyond debate that the best treatment for small HCC in a cirrhotic liver is liver transplantation since it achieves the best disease free and overall survival. Liver transplantation in the only modality that can remove the tumor as well as the tumor generating environment of cirrhosis. The only limitations are the paucity of availability of organs for transplantation, costs of transplantation and the risks of lifelong immunosuppression.
Small peripheral HCC in borderline or early cirrhosis who are not transplant candidates pose a dilemma to the liver surgeon to choose between one or more of the local procedures with equivalent results as resection to resection which carries a risk of post-operative decompensation of cirrhosis and mortality.
In experienced hands and in patients with good performance status with adequately sized functional remnant volumes, resection with a parenchyma sparing approach may achieve reasonable results. This may even serve as a bridge to transplantation for patients who subsequently recur within the liver without a major decline in survival.
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