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A 74-year-old man with HCV-related compensated cirrhosis, a past smoking habit, with well-controlled diabetes, and a BMI 28 kg/m² was successfully treated with direct-acting antivirals (DAA) in June 2017. Since treatment, his transaminase levels have remained normal (pre-treatment Liver Stiffness 21 kPa). The patient has been monitored regularly with ultrasound (US) every 6 months. The last US (December 2024) showed a lesion in S5 of 29 mm. He underwent a contrast MR that confirmed the presence of a single 37 mm nodule "LI-RADS 5", subcapsular and no evidence of macrovascular invasion or extra-hepatic localisations. A chest CT scan excluded lung metastases. The patient is asymptomatic with preserved liver function (Child-Pugh A, MELD-Na 8, platelet count 115 10⁹/L, total bilirubin 1.5 mg/dL). AFP is 106 ng/dL. Last endoscopy (2023) showed no evidence of oesophageal varices.

Do you think this patient should be considered for liver resection followed by adjuvant treatment for 12 months?

A. After a multiparametric evaluation, the patient can be treated with surgical resection, while adjuvant treatment is not recommended.

B. Surgical resection should be avoided, and locoregional treatment should be preferred, mainly thermal ablation technique (radiofrequency or microwave). Adjuvant treatment should be proposed due to the risk of recurrence.

C. The patient can be considered for liver resection only after achieving downsizing/downstaging by locoregional treatment, after a histological confirmation for definitive diagnosis of HCC. Adjuvant treatment is not recommended.

D. After a multiparametric evaluation, the patient can be treated with surgical resection, only if minimally invasive approaches are available. Adjuvant treatment should be considered, if high risk features of recurrence are detected.

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