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Surgical Management of Early-Stage Hepatocellular Carcinoma: Resection or Transplantation? |
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| Authors: | Emily C. Bellavance Kimberly M. Lumpkins Gilles Mentha Hugo P. Marques Lorenzo Capussotti Carlo Pulitano Pietro Majno Paulo Mira Laura Rubbia-Brandt Alessandro Ferrero Luca Aldrighetti Steven Cunningham Nadia Russolillo Benjamin Philosophe Eduardo Barroso Timothy M. Pawlik |
| Affiliation: | 1. Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA 2. Department of Transplantation and Visceral Surgery, University Hospitals of Geneva, 1211, Geneva 14, Switzerland 3. Hepato-Biliary-Pancreatic and Transplantation Center, Curry Cabral Hospital, Lisbon, Portugal 4. Unit of Hepato-Biliary-Pancreatic Surgery, A.O. Ordine Mauriziano, Turin, Italy 5. Department of Surgery, Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy 6. Department of Clinical Pathology, University Hospitals of Geneva, 1211, Geneva 14, Switzerland 7. Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA 8. The Johns Hopkins Hospital, 600 N Wolfe St, Halsted 614, Baltimore, MD, 21287, USA |
| Abstract: | Background The surgical management of hepatocellular carcinoma in patients with well-compensated cirrhosis is controversial. The purpose of the current study was to compare the outcome of patients with well-compensated cirrhosis and early stage hepatocellular carcinoma treated with initial hepatic resection versus transplantation. Methods Between 1985 and 2008, 245 patients underwent hepatic resection, and 134 patients underwent liver transplantation for early stage hepatocellular carcinoma. All patients had well-compensated cirrhosis. Prognostic factors were evaluated using univariate and multivariate analyses; survival was calculated using the Kaplan–Meier method. Results Compared with transplantation, patients undergoing resection had larger tumors and a higher incidence of microscopic vascular invasion. Transplantation was associated with better 5-year disease-free and overall survival compared with resection. Hepatitis status, presence of microscopic vascular invasion, and tumor size were predictors for recurrence, while the presence of microscopic vascular invasion and tumor size conferred an increased risk of death. The disease-free survival advantage with transplantation was more pronounced in hepatitis C patients compared with non-hepatitis and hepatitis B patients. The overall survival advantage with transplantation persisted in cases of solitary lesions ≤3 cm, but was attenuated in patients with a MELD score ≤ 8. Conclusion In well-compensated cirrhotic patients with early stage hepatocellular carcinoma, transplantation was associated with longer disease-free and overall survival. Patients undergoing resection did, however, have tumors with more advanced pathologic features. Patients best suited for initial resection as the treatment of hepatocellular carcinoma were those with a MELD score ≤ 8 without evidence of hepatitis. Presented at the 49th Annual Meeting of The Society for Surgery of the Alimentary Tract, May 18, 2008, San Diego, CA, USA. |
| Keywords: | Hepatocellular carcinoma Early stage Resection Transplantation Outcome |
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