A 60-year-old man with chronic hepatitis B-related cirrhosis (Child-Pugh A, MELD 9) has a single 2.5 cm hepatocellular carcinoma on surveillance CT. Contrast-enhanced MRI shows arterial enhancement with washout on portal venous phase. AFP is 450 ng/mL. He is within Milan criteria. The PREFERRED treatment per AASLD/EASL guidelines for this patient as a bridge/definitive therapy is:
- A Surgical resection (hepatectomy) ✓
- B Sorafenib (targeted therapy)
- C Transarterial chemoembolisation (TACE)
- D Radiofrequency ablation (RFA)
Correct answer: A. Surgical resection (hepatectomy)
Explanation
For a solitary HCC ≤ 3 cm in a Child-Pugh A patient with sufficient future liver remnant, surgical resection offers the best long-term survival and is the preferred curative option per AASLD 2023 guidelines. RFA is an acceptable alternative for lesions ≤ 3 cm in surgically unfit patients. TACE is palliative/bridging for transplant candidates or intermediate-stage BCLC-B. Sorafenib is systemic therapy reserved for advanced BCLC-C disease. Within Milan criteria, liver transplantation may also be considered.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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