Collectively, our findings indicate that the clinical course of HCC, even in very early (T1) and early stage (T2), varies widely and can be only partially predicted by current staging systems, which are mainly based on size and number of tumor nodules.21, 22 Differences in the clinical outcome of HCCs diagnosed at the same stage in patients with preserved liver function may reflect biological differences of the tumor and cirrhotic liver tissue.37, 38 This study also shows that mortality unrelated to cancer progression

has an important impact on the survival of HCC patients, who in Western countries are generally elderly.3, 4, 32 In conclusion, our ability to select optimal treatment strategies for patients with cirrhosis with HCCs is currently limited by three factors: (1) unpredictability of tumor progression and de novo carcinogenesis37,38; selleck chemical (2) tumor understaging14; and (3) substantial risk of HCC-unrelated death. Safe, effective, and minimally invasive treatments, thus, seem to be the most reasonable approach for HCC patients. Our experience indicates that RFA should be the treatment of choice for patients with one or two small HCCs, whereas surgical resection can be reserved for patients with preserved liver function whose tumors cannot be treated with RFA or in which RFA did not produce CR. It is important to recall

that RFA failure does not preclude subsequent R788 molecular weight surgical resection, whereas surgery can compromise the residual liver function, making subsequent RFA useless. On the other hand, neither RFA nor surgical resection is appropriate in the group of patients who, although successful treated for early/very-early (T1, T2) HCC, develop advanced nonlocal recurrences

shortly after treatment (Table 3). To improve our ability to define effective selleck chemicals individualized strategies for the management of this complex disease, future research should focus on the identification of tumor cell markers and/or genetic profiles associated with specific patterns of HCC growth. The authors thank all of the radiologists, pathologists, and surgeons who worked with us in the management of these patients for many years. We also thank Annalisa De Silvestri, M.D., for help provided in data analysis and Marian Everett Kent for editing the article. Ms. Kent received payment for this service from the IRCCS Policlinico San Matteo Foundation (Pavia, Italy). She has seen and approved the final version of the article and has no conflicts of interest to disclose. Additional supporting information may be found in the online version of this article. “
“Early complications after liver transplantation include bleeding, bile leaks, anastomotic and non-anastomotic biliary strictures, and hepatic artery or portal vein thrombosis.