Only potential curative options are resection or liver transplantation Among those who are not candidates for

resection, those with cirrhosis and HCC can be candidates for liver transplantation Liver transplantation is attractive b/c it involves resection of the malignant tumor while also replacing the cirrhotic liver that can be at risk of developing new lesions If localized HCC and candidate for surgical resection, then resection rather than transplantation. If not candidate for resection but meet Milan criteria, then liver transplantation is recommended. If wait time >6 months, then try radiofrequency ablation or chemoembolization. Surgical resection determined partly by the severity of liver disease which is based on the Child-Pugh classification or MELD score Curative partial hepatectomy is the optimal treatment for HCC resectability is based on no extrahepatic spread and the size and location of the tumor relative to the patients underlying liver function will permit resection w/o excess morbidity and mortality Suitable for resection if localized HCC w/o radiologic evidence of vasculature invasion of liver, preserved hepatic function, no portal htn, o Unresectable if extrahepatic extension, large inlotrahepatic disease, inadequate functional hepatic reserve, presence of confluence of the portal and hepatic veins Tumor extent is assessed with CT. In patients with cirrhosis, surgical resection is most safely performed in those with Child-Pugh class A disease