[Hepatocellular carcinoma on cirrhosis. Resection or transplantation]

In cirrhotic patients who develop hepatocellular carcinoma the only hope of prolonged survival is surgery. A review of the literature was carried out in order to determine precisely the indications for surgical treatment and the choice between liver resection and transplantation. With a low post-operative mortality rate, the survival rate 3 years after liver resection is almost 50 percent. The most favourable cases are tumours smaller than 5 cm, uninodular and well encapsulated, but intrahepatic recurrences are almost constant at 5 years. Liver transplantation does not improve the long-term survival. Its best indications are the same as those of liver resection. Because of graft scarcity and rapid tumoral progress in patients on the waiting list, liver transplantation must be reserved for unstable cirrhosis. In the other situations, liver resection must be considered in priority.