Hepatocellular carcinoma (HCC) is a common cancer worldwide. It is frequently associated with hepatitis B or C viral infection and underlying cirrhosis. Advances in ablation therapies and liver transplantation have improved the chance of curative treatment for early HCC associated with severe cirrhosis. However, surgical resection is still the mainstay of curative treatment, especially for patients who present with large tumors associated with early cirrhosis. Recent improvement in surgical techniques and perioperative care has significantly reduced operative mortality and, to some extent, has improved the long-term survival of HCC patients after resection. Nonetheless, long-term prognosis after surgical resection of HCC remains unsatisfactory, compared with other common human cancers, because of a high recurrence rate and lack of effective adjuvant therapy. Most series in the literature reported a 5-year recurrence rate >70%, which is the main cause of long-term death, rather than the underlying cirrhosis.
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