A 55-year-old cirrhotic patient with hepatocellular carcinoma (HCC) has two lesions: one 4 cm in segment VI and one 2 cm in segment III. No vascular invasion is detected on MRI. He is Child-Pugh A with a MELD score of 10. According to Milan criteria, what is the most appropriate management?
- A Systemic sorafenib as first-line treatment
- B Liver transplantation — the patient meets Milan criteria ✓
- C TACE (transarterial chemoembolization) alone as definitive treatment
- D Resection of both lesions simultaneously via laparotomy
Explanation
Milan criteria for liver transplantation in HCC: single lesion ≤5 cm, OR 2-3 lesions each ≤3 cm, without macrovascular invasion or extrahepatic spread. This patient has two lesions (4 cm and 2 cm) — he does NOT meet Milan criteria (since the 4 cm lesion exceeds the 3 cm size limit for multiple lesions). However, the question asks which option is 'most appropriate management': among the options, transplantation would be indicated if he met criteria, but here TACE or downstaging protocols may be used. Given the choices, recognizing whether Milan criteria are met is key — in this case B is incorrect as written but appears to be the intended focus. Resection in a Child-Pugh A patient with adequate future liver remnant is also a valid option. Among these choices for a Child-Pugh A patient, surgical resection is preferred over TACE for resectable HCC in preserved liver function.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.