Background: More than two decades have gone by since the early report of resection for small hepatocellular carcinoma (HCC), which resulted in improved prognosis of HCC.
Objective: To review the past and recent data, and prospect the future in this field.
Data sources: Literature and recent data from the Liver Cancer Institute of Fudan University, Shanghai, China.
Data synthesis: 1232 patients with small HCC from the institute were analyzed between 1960-1984 (n=107) and 1985-1999 (n=1125). The increase of limited resection rate from 69.5% to 82.5% contributed in part to the increase of resectability from 76.6% to 95.5%, decrease of operative mortality from 2.4% to 1.2%, and improvement of 5-year survival after resection (from 53.1% to 64.0%). The 5-year survival was higher after limited resection than after lobectomy, being 64.4% versus 55.9%. The 5-year survival after resection was superior to that after cryosurgery and other regional cancer therapies (32.8%). However, molecular studies found that biological characteristics were only slightly better in small HCC than in large HCC.
Conclusions: Resection remains the treatment choice for small HCC with compensated liver function, while regional cancer therapies and liver transplantation are alternatives for patients with incompensated liver function. Biological characteristics remain the leading factor influencing prognosis of small HCC.