{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T17:00:25Z","timestamp":1784653225024,"version":"3.55.0"},"reference-count":92,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Liver Dis"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:p>In the treatment of early hepatocellular carcinoma (HCC), resection ablation and transplantation have had excellent initial success. Choices have to be based on a broad and long-term vision integrating\u2014besides patients' interests\u2014the community's needs and resources. In this scenario, guidelines such as the Barcelona Clinic Liver Cancer (BCLC) staging system can be viewed as a hideous frame (symbolized by the myth of Procrustes, Poseidon's son who stretched or maimed travelers to fit into his bed), or as a useful structure against which personalized or innovative treatments must be reality checked. In this article, the latter view is taken: For resection, portal hypertension must still represent a powerful caveat, particularly because of poor long-term results. Expansion of the criteria may instead be explored for multiple tumors and vascular invasion, where good indications can consistently be selected in expert surgical centers. For ablation, competitive results can be obtained although a small, but appreciable proportion of patients with early vascular invasion (\u223c 10%), as they could probably benefit from anatomical resections. Conversely, ablative techniques overcoming the location and size limitations are developing and may prove competitive. For transplantation, several equivalent careful expansions of Milan's Criteria can be accepted, but as more patients have access to the waiting list\u2014often prioritized on non-HCC indications\u2014current allocation models prove to be insufficient, if not plainly inequitable, and should be revised.<\/jats:p>","DOI":"10.1055\/s-0034-1394365","type":"journal-article","created":{"date-parts":[[2014,11,4]],"date-time":"2014-11-04T23:47:13Z","timestamp":1415144833000},"page":"415-426","source":"Crossref","is-referenced-by-count":63,"title":["Early Hepatocellular Carcinoma on the Procrustean Bed of Ablation, Resection, and Transplantation"],"prefix":"10.1055","volume":"34","author":[{"given":"Riccardo","family":"Lencioni","sequence":"first","affiliation":[{"name":"Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Viareggio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Majno","sequence":"first","affiliation":[{"name":"Hepatobiliary Centre, Visceral Surgery and Transplantation Units, University Hospitals of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Mazzaferro","sequence":"additional","affiliation":[{"name":"Gastrointestinal Surgery and Liver Transplantation Units, National Cancer Institute INT, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2014,11,4]]},"reference":[{"issue":"9","key":"ref2","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1038\/sj.bjc.6604710","article-title":"Cancer mortality in the United Kingdom: projections to the year 2025","volume":"99","year":"2008","journal-title":"Br J Cancer"},{"issue":"2","key":"ref3","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1053\/j.gastro.2009.09.067","article-title":"Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression","volume":"138","year":"2010","journal-title":"Gastroenterology"},{"issue":"18","key":"ref4","doi-asserted-by":"crossref","first-page":"2824","DOI":"10.1002\/cncr.28730","article-title":"The clinical management of hepatocellular carcinoma in the United States, Europe, and Asia: A comprehensive and evidence-based comparison and review","volume":"120","year":"2014","journal-title":"Cancer"},{"issue":"3","key":"ref5","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1002\/hep.24199","article-title":"Management of hepatocellular carcinoma: an update","volume":"53","year":"2011","journal-title":"Hepatology"},{"issue":"4","key":"ref6","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/j.jhep.2011.12.001","article-title":"EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma","volume":"56","year":"2012","journal-title":"J Hepatol"},{"issue":"S 07","key":"ref7","first-page":"vii41","article-title":"Hepatocellular carcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"23","year":"2012","journal-title":"Ann Oncol"},{"issue":"5","key":"ref8","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1097\/SLA.0b013e31828329b8","article-title":"A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL\/AASLD recommendations?: an observational study of the HCC East-West study group","volume":"257","year":"2013","journal-title":"Ann Surg"},{"key":"ref9","article-title":"Dissecting EASL\/AASLD Recommendations With a More Careful Knife: A Comment on \u201cSurgical Misinterpretation\u201d of the BCLC Staging System","year":"2013","journal-title":"Ann Surg"},{"key":"ref10","article-title":"A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL\/AASLD recommendations? 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