Liver resection for multifocal hepatocellular carcinoma: is it an option?

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. At first diagnosis, HCC is multifocal in about 35–40% of patients (1,2). According to Western guidelines, the treatment of multifocal (non-metastatic) HCC is well codified: transplantation is indicated for HCCs within Milan criteria (2–3 nodules ≤30 mm), ablation for non-transplantable HCCs within Milan criteria, and chemoembolization for the remaining patients (3). Liver resection has no role. Daily practice is much more complex. The term multinodular HCC encompasses a wide range of scenarios, from oligonodular to diffuse disease, from multicentric to metastatic tumors, that require a case-by-case tailored treatment. We are still far from a real solution and several issues deserve further investigations, including the role of surgery, as highlighted by the recently published Japanese series of liver resections for multiple HCCs (1).