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Liver Transplantation and Liver Resection for Cirrhotic Patients with Hepatocellular Carcinoma: Comparison of Long-Term Survivals

Journal of Gastrointestinal Surgery volume 22, pages 840–848 (2018)Cite this article

Abstract

Background

Both liver transplantation (LT) and liver resection (LR) represent curative treatment options for hepatocellular carcinoma (HCC) in patients with liver cirrhosis. In this study, we have compared outcomes between historical and more recent patient cohorts scheduled either for LT or LR, respectively.

Methods

Clinicopathological data of all patients with HCC and cirrhosis who underwent LT or LR between 1989 and 2011 were evaluated. Overall survival of patients with HCC within the Milan criteria (MC) was analyzed focusing on changes between different time periods.

Results

In total, 364 and 141 patients underwent LT and LR for HCC in cirrhosis, respectively. Among patients with HCC within MC, 214 and 59 underwent LT and LR, respectively. Postoperative morbidity (37 vs. 11%, P < .0001), but not mortality (3 vs. 1%, P = .165), was higher after LR than after LT for HCC within MC. In the period 1989–2004, overall survival (OS) was significantly higher in patients who underwent LT compared to LR for HCC within MC (5-year OS: 77 vs. 36%, P < .0001). Interestingly, in the more recent period 2005–2011, OS was comparable between LT and LR for HCC within MC (5-year OS: 73 vs. 61%, P = .07).

Conclusion

We have noted an improvement of outcomes among patients selected for partial hepatectomy in recent years that were comparable to stable results after LT in cirrhotic patients with HCC. Whether those improvements are due to advances in liver surgery, optimized perioperative managament for patients with liver cirrhosis, and the development of modern multimodal treatment strategies for the recurrent lesions appears plausible.

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Author information

Affiliations

  1. Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Felix Krenzien, Moritz Schmelzle, Benjamin Struecker, Nathanael Raschzok, Christian Benzing, Maximilian Jara, Marcus Bahra, Robert Öllinger, Igor M. Sauer, Andreas Pascher, Johann Pratschke & Andreas Andreou

  2. Berlin Institute of Health (BIH), Berlin, Germany

    Felix Krenzien, Benjamin Struecker & Nathanael Raschzok

  3. Berlin School of Integrative Oncology (BSIO), Berlin, Germany

    Andreas Andreou

Authors
  1. Felix Krenzien
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  2. Moritz Schmelzle
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  3. Benjamin Struecker
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  4. Nathanael Raschzok
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  5. Christian Benzing
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  6. Maximilian Jara
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  7. Marcus Bahra
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  8. Robert Öllinger
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  9. Igor M. Sauer
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  10. Andreas Pascher
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  11. Johann Pratschke
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  12. Andreas Andreou
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Contributions

Felix Krenzien, Benjamin Struecker, Nathanael Raschzok, Christian Benzing, Maximilian Jara, Marcus Bahra, Robert Öllinger, Igor M. Sauer, Andreas Pascher, Moritz Schmelzle, Johann Pratschke, Andreas Andreou: contribution meets all criteria.

Corresponding author

Correspondence to Andreas Andreou.

Ethics declarations

This retrospective study was conducted at the Department of Surgery of the Charité, Campus Virchow-Klinikum, Berlin, Germany, and was officially approved by the Institutional Review Board (EA2/150/13).

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Accepted for oral presentation at the 12th Biennial International Congress of the European-African Hepato-Pancreato-Biliary Association in Mainz, Germany, May 2017.

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Krenzien, F., Schmelzle, M., Struecker, B. et al. Liver Transplantation and Liver Resection for Cirrhotic Patients with Hepatocellular Carcinoma: Comparison of Long-Term Survivals. J Gastrointest Surg 22, 840–848 (2018). https://doi.org/10.1007/s11605-018-3690-4

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  • DOI: https://doi.org/10.1007/s11605-018-3690-4

Keywords

  • Hepatocellular carcinoma
  • Liver transplantation
  • Liver resection