2008 ssat plenary presentation

Journal of Gastrointestinal Surgery

, Volume 12, Issue 10, pp 1699-1708

Surgical Management of Early-Stage Hepatocellular Carcinoma: Resection or Transplantation?

  • Emily C. BellavanceAffiliated withDepartment of Surgery, University of Maryland Medical Center
  • , Kimberly M. LumpkinsAffiliated withDepartment of Surgery, University of Maryland Medical Center
  • , Gilles MenthaAffiliated withDepartment of Transplantation and Visceral Surgery, University Hospitals of Geneva
  • , Hugo P. MarquesAffiliated withHepato-Biliary-Pancreatic and Transplantation Center, Curry Cabral Hospital
  • , Lorenzo CapussottiAffiliated withUnit of Hepato-Biliary-Pancreatic Surgery, A.O. Ordine Mauriziano
  • , Carlo PulitanoAffiliated withDepartment of Surgery, Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University
  • , Pietro MajnoAffiliated withDepartment of Transplantation and Visceral Surgery, University Hospitals of Geneva
  • , Paulo MiraAffiliated withHepato-Biliary-Pancreatic and Transplantation Center, Curry Cabral Hospital
  • , Laura Rubbia-BrandtAffiliated withDepartment of Clinical Pathology, University Hospitals of Geneva
    • , Alessandro FerreroAffiliated withUnit of Hepato-Biliary-Pancreatic Surgery, A.O. Ordine Mauriziano
    • , Luca AldrighettiAffiliated withHepato-Biliary-Pancreatic and Transplantation Center, Curry Cabral Hospital
    • , Steven CunninghamAffiliated withDepartment of Surgery, University of Maryland Medical Center
    • , Nadia RussolilloAffiliated withUnit of Hepato-Biliary-Pancreatic Surgery, A.O. Ordine Mauriziano
    • , Benjamin PhilosopheAffiliated withDepartment of Surgery, University of Maryland Medical Center
    • , Eduardo BarrosoAffiliated withHepato-Biliary-Pancreatic and Transplantation Center, Curry Cabral Hospital
    • , Timothy M. PawlikAffiliated withDepartment of Surgery, Division of Surgical Oncology, The Johns Hopkins University School of MedicineThe Johns Hopkins Hospital Email author 

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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.

Keywords

Hepatocellular carcinoma Early stage Resection Transplantation Outcome