Hepatocellular cancer: Resection or transplantation |
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Authors: | Jan Dmitrewski Galal El-Gazzaz and Paul McMaster |
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Institution: | (1) The Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK, GB |
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Abstract: | Surgery remains the treatment of choice for hepatocellular carcinoma (HCC). For HCC without underlying cirrhosis resection
remains the mainstay treatment option. Prognosis depends on the stage of the tumor. Survival appears to be better for small
(less than 5 cm) solitary tumors with negative resection margins and absence of vascular invasion. At present, liver transplantation
does not have an established role in the treatment of HCC in a non-cirrhotic liver. Because of the high recurrence rate, it
should not be considered for more advanced disease which is not amenable to resection. The surgical approach in cirrhotics
depends not only on the stage of the tumor but also on the liver functional reserve. Tumor size, presence of multifocal disease,
and vascular invasion determine the risk of HCC recurrence after resection, and the functional stability of the liver determines
both resectability and outcome. In societies in which transplantation is not available, small tumors will be treated with
liver resection. The outcome in patients with well preserved liver function is relatively good, at least in the medium term.
However, recurrent tumor and progressive hepatic decompensation have significant adverse effects on long-term survival. Poor
functional reserve may be associated with significant perioperative mortality and lower survival due to progressive liver
failure. In our opinion, for small cirrhosis-related HCCs, liver transplantation offers better long-term prospects than resection.
Therefore, if liver transplantation is available as an option it should be considered as the treatment of choice, particularly
for younger patients with otherwise good life expectancy.
Received for publication on June 9, 1997; accepted on July 3, 1997 |
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Keywords: | : hepatocellular carcinoma liver resection liver transplantation |
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