Surgical treatment of hepatocellular carcinoma in cirrhosis

Hepatocellular carcinoma is one of the most frequent forms of cancer worldw ide and its diagnosis and treatment have changed substantially during the l ast few years. Recent advances in ultrasonography, spiral computed tomograp hy scan and nuclear magnetic resonance have further simplified the diagnost ic approach to hepatocellular carcinoma. Ultrasonography is the reference e xamination, giving a wide variety of information on tumour size, location, relationship with portal and hepatic veins and splanchnic haemodynamics. Su rgical resection and liver transplantation can both be defined as curative treatment while other techniques such as percutaneous ethanol injection and chemoembolization must be considered as palliative. Therapeutic strategies for hepatocellular carcinoma are based upon data concerning the characteri stics of the tumour, the functional status of non-tumoural liver parenchyma and patients' general conditions. Surgery of hepatocellular carcinoma in c irrhotic liver is mainly restricted by lack of functional hepatic reserve a nd by the limited capacity of hepatic regeneration. The best surgical resul ts are obtained in early tumoural stages which generally need limited resec tion. Nevertheless, major liver resections have a specific role in selected cases. Recurrence rate after surgical resection is high and is related to a large number of factors. For this reason, liver transplantation, removing at the same time, the tumour and the underlying disease, is considered, th eoretically, the best treatment for hepatocellular carcinoma, but its role is still debated and limited by difficult organ sharing. Integration of pre sent therapeutic schemes are under evaluation with promising preliminary re sults.