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The care for liver-diseased patients presenting with hepatocellular cancer (HCC) is changing rapidly. Many treatment possibilities and caregivers belonging to a multitude of specialities troubled the therapeutic algorithm of the liver cancer patients. HCC in both normal and diseased livers has to be considered firstly as a surgical disease. The possibilities of surgery, including liver resections, as well as liver transplantation, have been underestimated and even been minimalized mainly as a consequence of many studies promoting in an unlimited way all different kinds of locoregional non-surgical and systemic therapies. Locoregional therapies and surgical procedures should not be seen as competing, but as complementary treatment options. Locoregional therapies are of value if surgery is not possible; in the context of transplantation they have an important role as ‘downstaging procedures’ allowing for bringing of transplantable patients into the required inclusion criteria. Systemic therapies and living donor liver transplantation will without any doubt occupy a more important role in the future therapeutic scheme of HCC.

Hepatocellular cancer and liver transplantation: necessity to go from chaos to order