Surgery and transplantation for hepatocellular cancer.

1. Curative treatment of hepatocellular carcinoma (HCC) depends on early diagnosis. 2. The cure rate for operable HCC occurring in the absence of cirrhosis is only 10% to 25%. 3. Features of HCC in patients with cirrhosis that are associated with a 5-year survival rate of 75% after liver transplantation include (1) solitary tumor less than 5 cm; (2) 3 or fewer tumors, each less than 3 cm; and (3) absence of vascular invasion. 4. Advanced cirrhosis limits the widespread application of partial hepatectomy to patients with HCC. 5. Neoadjuvant therapy has not yet been proven to improve patient outcome for early-stage HCC that is promptly treated by transplantation.