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We appreciate the opportunity to comment on the controversial issues surrounding treatment options for patients with hepatocellular carcinoma. In the field of surgery or interventional radiology it is common to emphasise technical feasibility and early morbidity/mortality rather than medium/long-term survival. Expanding life expectancy of the patients in comparison with that offered by other treatments, or even no treatment, is the goal of therapy. In our review1 and in practice guidelines2 ,3 the recommendations were based on robust data from prospective studies, preferably randomised, in the target population that had the option of being investigated. In the setting of surgical resection there are now several studies showing that presence of vascular invasion, multifocal disease and portal hypertension are associated with a …
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.