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

  • 2008 ssat plenary presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

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Acknowledgments

The authors would like to thank Robert Anders, MD, Cinthia Drachenberg, MD, Nader Hanna, MD, Vasco Ribeiro, MD, Emanuel Vigia, MD, Sofia Carrelha, MD, Paulo Ramos, MD, and Jennifer Strub, MD for their assistance in the preparation of this manuscript.

Support: Dr. Pawlik is supported by Grant Number 1KL2RR025006-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

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Authors and Affiliations

  1. Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA

    Emily C. Bellavance, Kimberly M. Lumpkins, Steven Cunningham & Benjamin Philosophe

  2. Department of Transplantation and Visceral Surgery, University Hospitals of Geneva, 1211, Geneva 14, Switzerland

    Gilles Mentha & Pietro Majno

  3. Hepato-Biliary-Pancreatic and Transplantation Center, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques, Paulo Mira, Luca Aldrighetti & Eduardo Barroso

  4. Unit of Hepato-Biliary-Pancreatic Surgery, A.O. Ordine Mauriziano, Turin, Italy

    Lorenzo Capussotti, Alessandro Ferrero & Nadia Russolillo

  5. Department of Surgery, Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy

    Carlo Pulitano

  6. Department of Clinical Pathology, University Hospitals of Geneva, 1211, Geneva 14, Switzerland

    Laura Rubbia-Brandt

  7. Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timothy M. Pawlik

  8. The Johns Hopkins Hospital, 600 N Wolfe St, Halsted 614, Baltimore, MD, 21287, USA

    Timothy M. Pawlik

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  1. Emily C. Bellavance
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  2. Kimberly M. Lumpkins
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Correspondence to Timothy M. Pawlik.

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Bellavance, E.C., Lumpkins, K.M., Mentha, G. et al. Surgical Management of Early-Stage Hepatocellular Carcinoma: Resection or Transplantation?. J Gastrointest Surg 12, 1699–1708 (2008). https://doi.org/10.1007/s11605-008-0652-2

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