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Surgical management of hepatocellular carcinoma: Resection or transplantation?

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Liver resection or transplantation offers the best opportunity for cure of hepatocellular carcinoma (HCC). To determine the relative roles for resection and transplantation and to evaluate the patient and tumor characteristics that might predict survival, the records of 125 patients treated for nonfibrolamellar HCC at The Toronto Hospital between 1981 and 1996 were reviewed. No adjuvant chemotherapy or antiviral protocols were used. Resection was the first operation in 67 patients; one underwent re-resection. Sixty patients underwent transplantation including two who had previously had a resection; 40 had known or suspected HCC and 20 had incidental tumors identified in the explanted liver. The incidence of cirrhosis was 49% for resection and 88% for transplantation. The incidence of hepatitis B virus (HBV) was 58% and 33%, respectively. The operative mortality rate for resection was 4.4% (9.4% in cirrhotic and 0 in noncirrhotic patients) and 13.3 % for transplantation. The 5-year cumulative recurrence rate was 55% following resection and 20% following transplantation (P <0.001). The 5-year Kaplan-Meier survival rates were 38% for resection and 45% for transplantation—60% for transplanted HBV-negative and 17% for HBV-positive patients (P <0.001). After resection, recurrent HCC accounted for 86% of deaths, whereas recurrent HBV was responsible for 42 % of deaths after transplantation. By univariate analysis, following resection, vascular invasion, advanced stage, multiple tumors, and lack of a capsule were predictive of survival; cirrhosis, HBV, age, tumor size, number, and grade were not. By multivariate analysis, only vascular invasion was predictive for resection and HBV for transplantation. Resection and transplantation are complementary methods of treating HCC. With the current organ shortage, resection should be considered first-line treatment. HBV-positive patients with HCC should only undergo transplantation in combination with effective antiviral therapy.

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References

  1. Okuda K. Hepatocellular carcinoma: Recent progress. Hepatology 1992; 15:948–963.

    Article  PubMed  CAS  Google Scholar 

  2. Busitil RW, Farmer DG. The surgical treatment of primary hepatobiliary malignancy. Liver Transplant Surg 1996;2:114–130.

    Google Scholar 

  3. Ringe B, Pichlmayr R, Wittekind C, Tusch G. Surgical treatment of hepatocellular carcinoma: Experience with liver resection and transplantation in 198 patients. World J Surg 1991;15:270–285.

    Article  PubMed  CAS  Google Scholar 

  4. Kumada T, Nakano S, Takeda I, et al. Patterns of recurrence after initial treatment in patients with small hepatocellular carcinoma. Hepatology 1997;25:87–92.

    Article  PubMed  CAS  Google Scholar 

  5. Adachi E, Maeda T, Matsamata T, et al. Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma. Gastroenterology 1995;108:768–775.

    Article  PubMed  CAS  Google Scholar 

  6. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carinomas in patients with cirrhosis. N Engl J Med 1996;334:393–399.

    Google Scholar 

  7. Beahrs OH, Henson DE, Hutter RVD, Kennedy BJ, eds. Manual for Staging of Cancer. Philadelphia: JB Lippincott, 1992, pp 89–91.

    Google Scholar 

  8. Edmondson HA, Steiner PE. Primary carcinoma of the liver: A study of 100 cases among 48,900 necropsies. Cancer 1954; 7:462–503.

    Article  PubMed  CAS  Google Scholar 

  9. Foster JH, Berman MM. Solid liver tumors. In Ebert PA, ed. Major Problems in Clinical Surgery. Philadelphia: WB Saunders, 1977.

    Google Scholar 

  10. Franco D, Capussotti L, Smadja C, et al. Resection of hepatocellular carcinomas: Results in 72 European patients with cirrhosis. Gastroenterology 1990;98:733–738.

    PubMed  CAS  Google Scholar 

  11. Nagasue N, Kohno H, Chang Y-C, et al. Liver resection for hepatocellular carcinoma, results of 229 consecutive patients during 11 years. Ann Surg 1993;217:375–384.

    Article  PubMed  CAS  Google Scholar 

  12. Lai ECS, Phan S-T, Lo C-M, et al. Hepatic resection for hepatocellular carcinoma, an audit of 343 patients. Ann Surg 1995;221:291–298.

    Article  PubMed  CAS  Google Scholar 

  13. VautheyJN, Limstra D, Franceschi D, et al. Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. AmJ Surg 1995;169:28–35.

    Article  Google Scholar 

  14. Ikeda K, Saitoh S, Tsubota A, et al. Risk factors for tumor recurrence and prognosis after curative resection of hepatocellular carcinoma. Cancer 1993;71:19–25.

    Article  PubMed  CAS  Google Scholar 

  15. Ng IO, Lai ECS, Fau ST, et al. Prognostic significance of pathological features of hepatocellular carcinoma. Cancer 1995;176:2443–2448.

    Article  Google Scholar 

  16. R, Shimizu K, Ii T, et al. Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection. Gastroenterology 1994;106:720–727.

    Google Scholar 

  17. Pichlmayr R. Is there a place for liver grafting in malignancy? Transplant Proc 1988;20:478–482.

    PubMed  CAS  Google Scholar 

  18. Iwatsuki S, Gordon RD, Shaw BW Jr, et al. Role of liver transplantation in cancer therapy. Ann Surg 1985;202:401–407.

    Article  PubMed  CAS  Google Scholar 

  19. Bismuth H, Chiche L, Adam R, et al. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 1993;218:145–151.

    Article  PubMed  CAS  Google Scholar 

  20. Otto G, Heuschen U, Hofmann WT, et al. Is transplantation really superior to resection in the treatment of small hepatocellular carcinoma? Transplant Proc 1997;29:489–491.

    Article  PubMed  CAS  Google Scholar 

  21. Iwatsuki S, Starzl TE, Sheahan DG, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 1991;214:221–229.

    Article  PubMed  CAS  Google Scholar 

  22. Colella G, DeCarlis L, Rondinara GE. Is hepatocellular carcinoma in cirrhotics an actual indication for liver transplantation? Transplant Proc 1997;29:492–494.

    Article  PubMed  CAS  Google Scholar 

  23. Stone MJ, Klintmalm G, Polter D, et al. Neoadjuvant chemotherapy and liver transplantation for hepatocellular carcinoma. Gastroenterology 1993;104:196–202.

    PubMed  CAS  Google Scholar 

  24. Ohhoff KM, Rosove MH, Shackleton CR, et al. Adjuvant chemotherapy improves survival after liver transplantation for hepatocellular carcinoma. Ann Surg 1995;221:734–743.

    Article  Google Scholar 

  25. Nagasue N, Uchida M, Makino Y, et al. Incidence and factors associated with intrahepatic recurrence following resection if hepatocellular carcinoma. Gastroenterology 1993; 105:488–494.

    PubMed  CAS  Google Scholar 

  26. Izumi R, Shizumi K, Iyobe T, et al. Postoperative adjuvant hepatic arterial infusion of lipiodol containing anticancer drugs in patients with hepatocellular carcinoma. Hepatology 1994;20:295–301.

    Article  PubMed  CAS  Google Scholar 

  27. Muto Y, Moriwald H, Ninomya M, et al. Prevention of second primary tumors by an acyclic retinoid, polyprenoic acid, in patients with hepatocellular carinoma. N Engl J Med 1996; 334:1561–1567.

    Article  Google Scholar 

  28. Rizzi PM, Ryder SD, Ramage JK, et al. Neoadjuvant chemotherapy after liver transplantation for hepatocellular carcinoma. Transplant Proc 1994;26:3563–3569.

    Google Scholar 

  29. Chung SW, Toth JL, Rezieg M, et al. Liver transplantation for hepatocellular carcinoma. Am J Surg 1994;167:317–321.

    Article  PubMed  CAS  Google Scholar 

  30. Wong PY, McPeakeJR, Portmann B, et al. Clinical course and survival after liver transplantation for hepatitis B virus complicated by hepatocellular carcinoma. Am J Gastroenterol 1995;90:29–34.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Hepatobiliary/Pancreatic and Liver Transplantation Services, Departrnent of Surgery, University of Toronto, and The Toronto Hospital, Toronto, Ontario, Canada

    Benjamin Philosophe M.D., Paul D. Greig M.D., Alan W. Hemming M.D., Mark S. Cattral M.D., Ian Wanless M.D., Imran Rasul M.D., Nancy Baxter M.D., Bryce R. Taylor M.D. & Bernard Langer M.D.

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  1. Benjamin Philosophe M.D.
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  2. Paul D. Greig M.D.
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  3. Alan W. Hemming M.D.
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  4. Mark S. Cattral M.D.
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  5. Ian Wanless M.D.
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  6. Imran Rasul M.D.
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  7. Nancy Baxter M.D.
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  8. Bryce R. Taylor M.D.
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  9. Bernard Langer M.D.
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Philosophe, B., Greig, P.D., Hemming, A.W. et al. Surgical management of hepatocellular carcinoma: Resection or transplantation?. J Gastrointest Surg 2, 21–27 (1998). https://doi.org/10.1016/S1091-255X(98)80099-1

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  • DOI: https://doi.org/10.1016/S1091-255X(98)80099-1

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