Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan criteria: A RCT

Yin and colleagues are to be congratulated on having performed an RCT in such a challenging study population [1]. The results are strongly supportive of surgery in preference to transarterial chemoembolization (TACE), in patients beyond Milan criteria at BCLC B. But, the findings must be viewed with caution before a similar approach is pursued in different patient populations. Firstly, the disease aetiology was almost exclusively due to chronic hepatitis B infection. A recent UK study showed that 70% of cases of HCC were due to alcoholic liver disease, fatty liver disease, and cryptogenic disease, so the patient groups between geographical locations are clearly very different and thus not comparable.