Surgical resection

Surgery offers the only hope of cure of HCC. However, resection is not possible in many patients. The most common reasons for irresecti-bility are bilobar or multifocal disease and liver failure associated with cirrhosis. Non-cirrhotic patients can tolerate extensive hepatic resection through compensatory hypertrophy of the unaffected liver, but in cirrhotic patients even limited segmental resection can induce liver failure. Multicentric tumours are most common in patients with cirrhosis and resection of the primary tumour may leave other, undetected deposits; higher recurrence rates following resection are observed in cirrhotic compared with non-cirrhotic patients.

Liver transplantation is appropriate for some cirrhotic patients with HCC <3 cm and is preferred to resection in the treatment of HCC arising from hepatitis C because of the high likelihood of further tumour development in these patients.

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