Resection is the treatment of choice in HCC patients with near normal liver function. Child classification is still the most practical way of selecting candidates for partial hepatectomy. Patients with Child A cirrhosis and minimal portal hypertension (e.g. platelet count >100,000/mm3 and hepatic venous pressure gradient <10 mmHg) are ideal candidates for resection. Extend of underlying liver disease and metabolic reserve of liver parenchyma determine both resectability and postop patient survival.

Tumor size is not a limiting factor in the determination of resectability. Patients who have circumscribed single tumors are potentially resectable regardless of tumor size. However, patients with muItiple tumors are not good candidates for resection. Presence of multiple tumors strongly implies intrahepatic metastasis and high risk for recurrence. Tumor recurrence in remnant liver frequently originates from a metastatic foci of resected HCC. De-novo tumor may also occur in the potentially tumor producing remnant liver.

Survival rates after resection are in the range 80-92% at 1 year, 61-86% at 3 years, and 41-74% at 5 years. Liver function, including Child, degree of fibrosis, total bilirubin level, presence of clinical portal hypertension and platelet count may predict short-term survival. On the other hand, long-term results are closely related with tumor recurrence, which occurs in approximately 20%, 50% and 75% of patients at 1 year, 3 years and 5 years, respectively. Predictors of recurrence are tumor grade, microscopic and macroscopic vascular invasion, tumor size, number of tumors, presence of satellites, AFP levels, and positive surgical margins.