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World J Hepatol. Nov 27, 2014; 6(11): 766-775
Published online Nov 27, 2014. doi: 10.4254/wjh.v6.i11.766
Management of “very early” hepatocellular carcinoma on cirrhotic patients
Gonzalo Sapisochin, Elena Fernandez de Sevilla, Juan Echeverri, Ramón Charco
Gonzalo Sapisochin, Elena Fernandez de Sevilla, Juan Echeverri, Ramón Charco, Department of HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain
Author contributions: All authors contributed to this paper.
Correspondence to: Gonzalo Sapisochin, MD, PhD, Department of HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain. sapisochin@me.com
Telephone: +34-93-2746113 Fax: +34-93-2746112
Received: July 28, 2014
Revised: September 29, 2014
Accepted: October 14, 2014
Published online: November 27, 2014
Processing time: 115 Days and 10.4 Hours
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.