The management of patients with cirrhosis and early hepatocellular carcinoma (HCC) meeting the Milan criteria is controversial. Although liver transplantation for early HCC has been shown to have excellent long term survival rates and low recurrence rates, its application is limited by organ availability. Hepatic resection is an alternative therapy for early HCC. Hepatic resection can be performed safely in patients with early HCC and well-compensated cirrhosis. In addition, the reported 5-year survival rates are in the range of 50%. Resection may also allow a better understanding of tumor biology through pathologic examination of the specimen while also providing a potentially curative therapeutic option. The management of patients with early HCC is complex. Resection should not be viewed as opposing transplantation. Rather, hepatic resection should be seen as complementary to transplantation. The best therapeutic strategies for patients with early HCC and well-compensated cirrhosis should be dependent on the individual clinical situation, not adherence to dogmatic universal adoption of either resection or transplantation.