Journal of Gastrointestinal Surgery

, Volume 12, Issue 10, pp 1699–1708 | Cite as

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

  • Emily C. Bellavance
  • Kimberly M. Lumpkins
  • Gilles Mentha
  • Hugo P. Marques
  • Lorenzo Capussotti
  • Carlo Pulitano
  • Pietro Majno
  • Paulo Mira
  • Laura Rubbia-Brandt
  • Alessandro Ferrero
  • Luca Aldrighetti
  • Steven Cunningham
  • Nadia Russolillo
  • Benjamin Philosophe
  • Eduardo Barroso
  • Timothy M. Pawlik
2008 ssat plenary presentation



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.


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.


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.


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.


Hepatocellular carcinoma Early stage Resection Transplantation Outcome 


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Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Emily C. Bellavance
    • 1
  • Kimberly M. Lumpkins
    • 1
  • Gilles Mentha
    • 2
  • Hugo P. Marques
    • 3
  • Lorenzo Capussotti
    • 4
  • Carlo Pulitano
    • 5
  • Pietro Majno
    • 2
  • Paulo Mira
    • 3
  • Laura Rubbia-Brandt
    • 6
  • Alessandro Ferrero
    • 4
  • Luca Aldrighetti
    • 3
  • Steven Cunningham
    • 1
  • Nadia Russolillo
    • 4
  • Benjamin Philosophe
    • 1
  • Eduardo Barroso
    • 3
  • Timothy M. Pawlik
    • 7
    • 8
  1. 1.Department of SurgeryUniversity of Maryland Medical CenterBaltimoreUSA
  2. 2.Department of Transplantation and Visceral SurgeryUniversity Hospitals of GenevaGeneva 14Switzerland
  3. 3.Hepato-Biliary-Pancreatic and Transplantation CenterCurry Cabral HospitalLisbonPortugal
  4. 4.Unit of Hepato-Biliary-Pancreatic SurgeryA.O. Ordine MaurizianoTurinItaly
  5. 5.Department of Surgery, Liver Unit, Scientific Institute San RaffaeleVita-Salute San Raffaele UniversityMilanItaly
  6. 6.Department of Clinical PathologyUniversity Hospitals of GenevaGeneva 14Switzerland
  7. 7.Department of Surgery, Division of Surgical OncologyThe Johns Hopkins University School of MedicineBaltimoreUSA
  8. 8.The Johns Hopkins HospitalBaltimoreUSA

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