Oncological Outcomes of Hepatic Resection vs Transplantation for Localized Hepatocellular Carcinoma |
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| Affiliation: | 1. Department of Surgery, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary;2. 2nd Department of Medicine and Cardiology Centre, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary;3. 1st Department of Medicine, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary;4. Department for Medical Translation and Communication, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary;1. Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey;2. Department of General Surgery, Faculty of Medicine, Akdeniz University, Antalya, Turkey;3. Department of Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey;1. Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey;2. Organ Transplantation Center, Acibadem International Hospital, Istanbul, Turkey;1. Department of General Surgery, Kartal Training Hospital, Istanbul, Turkey;2. Department of Transplantation, Kartal Training Hospital, Istanbul, Turkey;3. Bahcesehir University, Department of General Surgery, Istanbul, Turkey;4. Department of Biochemistry, Yuzuncu Yil University, Van, Turkey;5. Department of Chest Diseases, Yeniyuzyil University, Istanbul, Turkey;6. Department of Nephrology, Tekirdag State Hospital, Tekirdag, Turkey;7. Bahcesehir University, Department of Nephrology, Istanbul, Turkey;1. Department of General Surgery, Bahcesehir University Faculty of Medicine, İstanbul, Turkey;2. Department of Internal Medicine, Kargı Ahmet Hamdi Akpinar State Hospital, Çorum, Turkey;3. Department of Nephrology, Sakarya University Faculty of Medicine, Sakarya, Turkey;1. Medical Biology and Genetics Department, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey;2. Tissue Typing Laboratory, Health Science University Tepecik Education and Research Hospital, Izmir, Turkey;3. Vocational School of Health Services, Izmir Katip Celebi University Izmir, Turkey;4. Nephrology, Health Science University Bozyaka Education and Research Hospital, Izmir, Turkey;5. General Surgery, Health Science University Bozyaka Education and Research Hospital, Izmir, Turkey |
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| Abstract: | BackgroundScarce data are available comparing outcomes of hepatic resection vs orthotopic liver transplantation (OLT) for localized hepatocellular carcinoma (HCC) patients both meeting and exceeding the Milan criteria. This study compared the clinical and oncological outcomes of patients undergoing hepatic resection vs transplantation localized HCC.MethodBetween January 2005 and February 2017, clinical and oncological outcomes of patients who underwent liver resection (n = 38) vs OLT (n = 28) for localized HCC were compared using a prospectively maintained database.ResultsA total of 66 patients (with a median age of 62) who met the study criteria were analyzed. Comparable postoperative complications (13.2% vs 28.6%, P = .45) and perioperative mortality rates (7.9% vs 10.7%, P = .2) were noted for the resection vs OLT groups. While Child-Pugh Class A patients were more prevalent in the resection group (78.9% vs 7.1%, P = .0001), the rate of patients who met the Milan criteria was higher in the OLT group (89.3% vs 34.25, P = .0001). Recurrence rates were 36.8% in the resection group and 3.6% in the OLT group at the end of the median follow-up period (32 vs 39 months, respectively). The HCC-related mortality rate was significantly higher in the resection group (39.5% vs 10.7%, P = .034).However, a subgroup analysis of patients who met the Milan criteria revealed similar rates of recurrence and HCC-related mortality (15.4% vs 8%, P = .63). Based on logistic regression analysis, number of tumors (P = .034, odds ratio: 2.1) and “resection”-type surgery (P = .008, odds ratio: 20.2) were independently associated with recurrence.ConclusionCompared to liver transplantation, hepatic resection for localized hepatocellular carcinoma is associated with a higher rate of recurrence and disease-related mortality. |
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