[Curative treatment of hepatocellular carcinoma]

Hepatocellular carcinoma is the leading cause of death in cirrhotic patients and the third most common cause of cancer-related death. The main prognosis factors are related to tumor status (defined by number and sze of nodules, cell differentiation grade, vascular invasion, and extrahepatic spread), liver function (defined by Child-Pugh class, bilirubin, albumin, portal hypertension) and genera health status. Only a minority of patients (20-30%) are deemed suitable for potentially curative treatments including orthotopic liver transplantation and surgical resection. Only radiofrequency thermal ablation can challenge surgery for small size tumors but as after resection, local intrahepatic recurrences are common. Orthotopic liver transplantation offers hope for cure of both complicating cancer and the underlying chronic liver disease, cirrhosis, and for achieve the best outcomes in well-selected candidates. Hepatic resection is the treatment of choice in non-cirrhotic patients, where major resections can be performed with low rates of life-threatening complications and acceptable outcome.