Achyut Saroj, Founder, Consultant, and Author at AwareOnc, KOL Engagement and Medical Affairs Liaison at Tatva Health, shared a post on LinkedIn:
“Wait or Ablate? The Debate Over T1 HCC Management
I recently came across an insightful debate from the UCSF Liver Transplant conference (2013) regarding the management of very early-stage Hepatocellular Carcinoma (HCC) specifically T1 lesions measuring 1 to 1.9 cm.
The discussion centered on a significant clinical dilemma: under current organ allocation policies, patients with T1 lesions are not eligible for priority listing for liver transplantation. This leads to two conflicting strategies:
1. The ‘Wait and Not Ablate’ Strategy
Dr. Neil Mehta argued for waiting until the tumor naturally progresses to T2 criteria (2 cm or more) before treating.
The Logic: Reaching T2 status allows the patient to qualify for MELD exception points, leading to a liver transplant that provides both a complete oncologic resection and a cure for the underlying liver dysfunction.
The Concern: Immediate Radiofrequency Ablation (RFA) for these small lesions is associated with high 5-year tumor recurrence rates, estimated between 38% and 60%.
2. The ‘Ablate Don’t Wait’ Strategy
Dr. Rio Hirose presented the counter-argument, favoring immediate treatment with RFA.
The Logic: RFA is a low-morbidity, outpatient procedure that can be highly effective for lesions under 2 cm, offering survival rates comparable to resection in some studies.
The Ethical Angle: Dr. Hirose highlighted the broader issue of organ allocation, questioning whether it is right to prioritize a stable HCC patient over sicker patients with high MELD scores in the ICU.
He suggested treating the cancer first and reserving transplant as a “salvage” option if the disease recurs.
The Takeaway:
Managing very early HCC isn’t just a clinical decision; it’s a balance of individual patient outcomes versus the ethical distribution of limited donor organs.
While waiting ensures a patient qualifies for a transplant, immediate ablation may prevent unnecessary major surgery while saving livers for those in more acute need.
How does your multidisciplinary team handle the “wait vs. treat” decision for T1 lesions in 2026? I’d love to hear your thoughts in the comments!”
More posts featuring Achyut Saroj.