Liver transplantation is the ideal treatment for patients affected by early stage hepatocellular carcinoma and chronic liver disease. Considering organs shortage, alternative treatments have to be adopted to minimize the waitlist drop-out, and in case of recurrence within the accepted criteria, salvage transplantation can be considered. Surgical resection is one of the most effective treatments, with the possibility of oncological radicality and pathological analysis of the specimen. Although these theoretical advantages, surgical strategy cannot be applied to all patients because of the impaired liver function as well as the amount of parenchyma to be resected does not allow a sufficient future liver remnant. Furthermore, resection by laparotomy may lead to strong intra-abdominal adhesions in a contest of portal hypertension and, as potential consequence, increase transplantation difficulty raising morbidity. Laparoscopic liver resection is now performed as a routine procedure in tertiary referral centers, with increasing evidence of long-term results comparable to traditional surgery together with the advantages of a minimally invasive approach. In addition, with a salvage transplantation strategy that has been shown to be comparable to primary transplantation, the patient can live with his native liver avoiding an invasive procedure and long-term immunosuppression, allowing the use of liver grafts for the community. We present the results of an Italian multicenter experience of salvage liver transplantation following the recurrence of HCC initially treated by laparoscopic resection in 31 patients, performed by four referral centers. Mean operative transplantation time was 450 min, morbidity was 41.9 %, 90-days mortality was 3.2 %, and median post-operative length of stay was 17.9 days. Salvage liver transplantation after laparoscopic liver resection for HCC is comparable to open surgery in terms of operative time, oncologic radicality, morbidity and mortality, with the advantages of laparoscopic surgery.
Salvage liver transplantation Hepatocellular carcinoma Laparoscopic liver surgery
This is a preview of subscription content, log in to check access.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Statement on the welfare of animals
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Yamashita Y, Yoshida Y, Kurihara T et al (2015) Surgical results for recurrent hepatocellular Carcinoma after curative hepatectomy: repeat hepatectomy vs. salvage living donor liver transplantation. Liver Transpl. doi:10.1002/lt.2411PubMedGoogle Scholar
El-Serag HB, Marrero JA, Rudolph L et al (2008) Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology 134:1752–1763PubMedCrossRefGoogle Scholar
Fuks D, Dokmak S, Paradis V et al (2012) Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology 55(1):132–140PubMedCrossRefGoogle Scholar
Huang J, Yan L, Cheng Z et al (2010) A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg 252:903–912PubMedCrossRefGoogle Scholar
Belghiti J, Carr BI, Greig PD et al (2008) Treatment before liver transplantation for HCC. Ann Surg Oncol 15:993–1000PubMedCrossRefGoogle Scholar
Cherqui D, Laurent A, Mocellin N et al (2009) Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation. Ann Surg 250:738–746PubMedCrossRefGoogle Scholar
Del Gaudio M, Ercolani G, Ravaioli M et al (2008) Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: University of Bologna experience. Am J Transpl 8:1177–1185CrossRefGoogle Scholar
Ishizawa T, Hasegawa K, Aoki T et al (2008) Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 134:1908–1916PubMedCrossRefGoogle Scholar
Cucchetti A, Vitale A, Gaudio MD et al (2010) Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma. Am J Transpl 10:619–627CrossRefGoogle Scholar
Poon RT, Fan ST, Lo CM et al (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 235:373–382PubMedCentralPubMedCrossRefGoogle Scholar
Poon RT, Fan ST, Lo CM et al (2007) Difference in tumor invasiveness in cirrhotic patients with hepatocellular carcinoma fulfilling the Milan criteria treated by resection and transplantation: impact on long-term survival. Ann Surg 245:51–58PubMedCentralPubMedCrossRefGoogle Scholar
Majno PE, Sarasin FP, Mentha G et al (2000) Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: an outcome-oriented decision analysis. Hepatology 31:899–906PubMedCrossRefGoogle Scholar
Laurent A, Cherqui D, Lesurtel M et al (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769PubMedCrossRefGoogle Scholar
Ettorre GM, Laurenzi A, Lionetti R et al (2014) Laparoscopic liver resections in normal and cirrhotic livers: a retrospective analysis in a tertiary hepato-biliary unit. Dig Liver Dis 46(4):353–357PubMedCrossRefGoogle Scholar
Giulianotti PC, Coratti A, Sbrana F et al (2011) Robotic liver surgery: results for 70 resections. Surgery 149:29–39PubMedCrossRefGoogle Scholar
Felli E, Vennarecci G, Ettorre GM, et al (2015) Robotic liver surgery: preliminary experience in a tertiary hepato-biliary unit. Updates Surg 67(1):27–32PubMedCrossRefGoogle Scholar
Dagher I, Di Giuro G, Dubrez J et al (2009) Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 198:173–177PubMedCrossRefGoogle Scholar
Cherqui D, LaurentA Tayar C et al (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506PubMedCentralPubMedCrossRefGoogle Scholar
Kazaryan AM, Marangos IP, Rosok BI et al (2010) Laparoscopic resection of colorectal liver metastases: surgical and long-term oncologic outcome. Ann Surg 252:1005–1012PubMedCrossRefGoogle Scholar
Castaing D, Vibert E, Ricca L et al (2009) Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg 250:849–855PubMedCrossRefGoogle Scholar
Nguyen KT, Laurent A, Dagher I et al (2009) Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg 250:842–848PubMedCrossRefGoogle Scholar
Sasaki A, Nitta H, Otsuka K et al (2009) Ten-year experience of totally laparoscopic liver resection in a single institution. Br J Surg 96:274–279PubMedCrossRefGoogle Scholar
Laurent A, Tayar C, Andréoletti M et al (2009) Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 16(3):310–314PubMedCrossRefGoogle Scholar