What is the definitive treatment for primary hepatocellular carcinoma?

The definitive treatment for primary hepatocellular carcinoma (HCC), particularly in patients with cirrhosis and without significant portal hypertension or extrahepatic spread, is liver transplant. This procedure not only removes the tumor but also addresses underlying liver disease, which is often a critical factor in patients with HCC.

Liver transplantation offers the advantage of curing both the cancer and the liver cirrhosis, which can be particularly beneficial since many patients with HCC also have underlying liver conditions that can compromise liver function. Moreover, transplantation ensures that there is no risk of residual tumor, which can happen with other treatments.

While surgical resection is a viable option in selected patients with adequate liver function and small tumors, it does not address the underlying liver disease and comes with substantial risks, including the potential for significant postoperative morbidity and mortality.

Radiofrequency ablation can be effective for small tumors, particularly in patients who are not surgical candidates, but it is generally considered a palliative treatment rather than a definitive one. Chemotherapy is typically not effective for HCC and is not considered a standard treatment for this cancer type. Thus, liver transplant stands out as the definitive therapy that provides the best long-term outcomes in appropriately selected patients.