Management of “very early” hepatocellular carcinoma on cirrhotic patients

Abstract

Due to the advances in screening of cirrhotic patients, hepatocellular carcinoma (HCC) is being diagnosed in earlier stages. For this reason the number of patients diagnosed of very early HCC (single tumors ≤ 2 cm) is continuously increasing. Once a patient has been diagnosed with this condition, treatment strategies include liver resection, local therapies or liver transplantation. The decision on which therapy should the patient undergo depends on the general patients performance status and liver disease. Anyway, even in patients with similar conditions, the best treatment offer is debatable. In this review we analyze the state of the art on the management of very early HCC on cirrhotic patients to address the best treatment strategy for this patient population.

Keywords: Hepatocellular carcinoma, Very early, Liver resection, Liver transplantation, Local therapies

Core tip: Very early hepatocellular carcinoma patients are deemed too early for liver transplantation candidacy, known as the best treatment regarding long-term survival and tumor recurrence. Strategies as surgical resection and radiofrequency ablation have gained popularity. Although resection is considered as the first line of treatment, recent studies claim equal results with ablation techniques. Ablation used as a test of time in patients who remain candidates for liver transplantation is attractive. In this review we will analyze in detail the novel strategy repertoire used in the management of these patients.