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Hepatocellular carcinoma (HCC) is the most frequent primary neoplasia of the liver and its incidence has risen and mainly affects subjects with cirrhosis. Globally, the main risk factor for HCC is hepatitis B virus linked or not to aflatoxin (1). Nevertheless, in industrialised countries, the most frequent risk factors associated with HCC are chronic infection caused by hepatitis C virus and ethanol ingestion (2). In the treatment of HCC, besides the size and number of nodules, also involved the patient's clinical status assessed by different methods (Child-Pough classification, MELD, ECOG performans status, indocyanine green levels, etc). Recently, the Barcelona Clinic group (3) provides a staging classification using the Child-Pough classification, performans status, Okuda classification, and evaluate the presence of portal hypertension and bilirubin levels.In the initial stages, the treatment options include: resection, liver transplant and ablation. In subjects with compensated cirrhosis, candidates for resection must be selected carefully and the liver function reserve must be tested (4). The best candidates for surgery are those with single tumours, those who present normal bilirubin and no clinically significant portal hypertension (5). HCC vascularisation is predominantly arterial and this establishes a specific vascular pattern characterised by intense contrast uptake in the arterial phase, followed by rapid wash out in the portal phase (6). Nevertheless, given that tumour spread via the veins originates in the area immediately surrounding the tumour, from an oncological point of view, it is worth performing a resection with a margin of 1 cm. Despite the strict selection process, the recurrence rate for this disease is very high and can reach 70 % after 5 years (4), recurrences of which, 70 % correspond to intrahepatic metastasis, that were not detected when the resection was carried out, and 30% are de novo HCC (7,8). On the basis of this, it was established that when liver transplants are limited to those subjects with single tumours that measure 5 cm or less or with a maximum of 3 nodules which measure less than 3 cm and that do not present vascular invasion or extrahepatic dissemination, a 4-year survival rate of 75 % and a recurrence rate of 8 % is obtained (9). In subjects with decompensated cirrhosis of the liver, resection is formally contraindicated and a liver transplant must be considered. In subjects with intermediate stage HCC (stage B according to HCC classification), the only treatment that has proven to be beneficial in terms

Transarterial Chemoembolization Prior to Early Hepatocellular Carcinoma Laparoscopic Resection in Patients with Child A Cirrhosis