Skip to main content

Advertisement

SpringerLink
Log in

An Analysis of Resection vs Transplantation for Early Hepatocellular Carcinoma: Defining the Optimal Therapy at a Single Institution

  • Hepatic and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The reported survival after liver transplantation (OLT) for early hepatocellular carcinoma (HCC) is superior to the results of liver resection (LR), but few analyses have considered long waiting times and patient drop-offs due to tumor progression.

Methods

From 1995–2005, 347 patients with HCC were evaluated at our institution and underwent either LR (n = 174) or placed on the OLT waiting list (n = 173). Patients who only underwent ablation were not included. After eliminating patients with 1) incidental tumors after OLT, 2) tumors outside of Milan criteria, 3) preoperative vascular invasion prior to LR and 4) Child-Pugh Class C cirrhosis prior to OLT, 261 patients (LR = 121; OLT = 140) were included in this analysis.

Results

Median follow-up time was 35 months. Median waiting time for OLT was 7.7 months; during this time, 30 patients were taken off the waiting list. Overall survival (OS) from time of listing or LR was not different between the two groups; 1, 3, and 5 year OS after LR was 89%, 75%, and 56% compared with 90%, 70%, and 64% for OLT (P = .84). Only patients who waited <4 months for OLT (n = 67) had better survival than those who underwent LR (P = .05). Patients who waited longer that four months for OLT had a 2.5× higher risk of death in a Cox multivariate model [odds ratio (OR) 2.5; 95% confidence interval (CI): 1.3–5; P = .007].

Conclusion

Unless waiting time is short (<4 months), the survival of patients with early HCC is similar between LR and LT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1.
FIG. 2.
FIG. 3.

Similar content being viewed by others

References

  1. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334:693–9

    Article  PubMed  CAS  Google Scholar 

  2. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60:646–9

    Article  PubMed  CAS  Google Scholar 

  3. Shah SA, Tan JC, McGilvray ID, et al. Accuracy of staging as a predictor for recurrence after liver transplantation for hepatocellular carcinoma. Transplantation 2006; 81:1633–9

    Article  PubMed  Google Scholar 

  4. Hemming AW, Cattral MS, Reed AI, et al. Liver transplantation for hepatocellular carcinoma. Ann Surg 2001; 233:652–9

    Article  PubMed  CAS  Google Scholar 

  5. Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma. Semin Liver Dis 2005; 25:181–200

    Article  PubMed  Google Scholar 

  6. Llovet JM, Fuster J, Bruix J. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl 2004; 10:S115–S120

    Article  PubMed  Google Scholar 

  7. Cha C, Fong Y, Jarnagin WR, et al. Predictors and patterns of recurrence after resection of hepatocellular carcinoma. J Am Coll Surg 2003; 197:753–8

    Article  PubMed  Google Scholar 

  8. Pawlik TM, Delman KA, Vauthey JN, et al. Tumor size predicts vascular invasion and histologic grade: Implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl 2005; 11:1086–92

    Article  PubMed  Google Scholar 

  9. Shah SA, Greig PD, Gallinger S, et al. Factors associated with early recurrence after resection for hepatocellular carcinoma and outcomes. J Am Coll Surg 2006; 202:275–83

    Article  PubMed  Google Scholar 

  10. Shah SA, Cleary SP, Wei AC, et al. Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment, and outcomes. Surgery 2007; 141:330–9

    Article  PubMed  Google Scholar 

  11. Roayaie S, Schwartz JD, Sung MW, et al. Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Liver Transpl 2004; 10:534–40

    Article  PubMed  Google Scholar 

  12. Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma. Semin Liver Dis 2005; 25:181–200

    Article  PubMed  Google Scholar 

  13. Vauthey JN, Lauwers GY, Esnaola NF, et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol 2002; 20:1527–36

    Article  PubMed  Google Scholar 

  14. Pawlik TM, Poon RT, Abdalla EK, et al. Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg 2005; 140:450–7

    Article  PubMed  Google Scholar 

  15. Shah SA, Levy GA, Adcock LD, et al. Adult-to-adult living donor liver transplantation. Can J Gastroenterol 2006; 20:339–43

    PubMed  Google Scholar 

  16. Wiesner RH, Freeman RB, Mulligan DC. Liver transplantation for hepatocellular cancer: the impact of the MELD allocation policy. Gastroenterology 2004; 127:S261–-S267

    Article  PubMed  Google Scholar 

  17. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria. Liver Transpl 2002; 8:765–74

    Article  PubMed  Google Scholar 

  18. Roayaie S, Frischer JS, Emre SH, et al. Long-term results with multimodal adjuvant therapy and liver transplantation for the treatment of hepatocellular carcinomas larger than 5 centimeters. Ann Surg 2002; 235:533–9

    Article  PubMed  Google Scholar 

  19. Molmenti EP, Klintmalm GB. Liver transplantation in association with hepatocellular carcinoma: an update of the International Tumor Registry. Liver Transpl 2002; 8:736–48

    Article  PubMed  Google Scholar 

  20. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33:1394–1403

    Article  PubMed  CAS  Google Scholar 

  21. Majno PE, Sarasin FP, Mentha G, et al. 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 2000; 31:899–906

    Article  PubMed  CAS  Google Scholar 

  22. Adam R, Azoulay D, Castaing D, et al. Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? Ann Surg 2003; 238:508–18

    Article  PubMed  Google Scholar 

  23. Freeman RB, Edwards EB, Harper AM. Waiting list removal rates among patients with chronic and malignant liver diseases. Am J Transplant 2006; 6:1416–21

    Article  PubMed  CAS  Google Scholar 

  24. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999; 30:1434–40

    Article  PubMed  CAS  Google Scholar 

  25. Llovet JM, Bruix J, Gores GJ. Surgical resection versus transplantation for early hepatocellular carcinoma: clues for the best strategy. Hepatology 2000; 31:1019–21

    Article  PubMed  CAS  Google Scholar 

  26. Roayaie S, Haim MB, Emre S, et al. Comparison of surgical outcomes for hepatocellular carcinoma in patients with hepatitis B versus hepatitis C: a western experience. Ann Surg Oncol 2000; 7:764–70

    Article  PubMed  CAS  Google Scholar 

  27. Yao FY, Bass NM, Nikolai B, et al. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. Liver Transpl 2003; 9:684–92

    Article  PubMed  Google Scholar 

  28. Adam R, Azoulay D, Castaing D, et al. Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? Ann Surg 2003; 238:508–18

    Article  PubMed  Google Scholar 

  29. Freeman RB, Mithoefer A, Ruthazer R, et al. Optimizing staging for hepatocellular carcinoma before liver transplantation: A retrospective analysis of the UNOS/OPTN database. Liver Transpl 2006; 12:1504–11

    Article  PubMed  Google Scholar 

  30. Sasaki Y, Yamada T, Tanaka H, et al. Risk of recurrence in a long-term follow-up after surgery in 417 patients with hepatitis B- or hepatitis C-related hepatocellular carcinoma. Ann Surg 2006; 244:771–80

    Article  PubMed  Google Scholar 

  31. Huo TI, Wu JC, Hsia CY, et al. Hepatitis C virus infection is a risk factor for tumor recurrence after resection of small hepatocellular carcinomas. World J Surg 2004; 28:787–91

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Health Network, University of Toronto, Toronto, Canada

    Shimul A. Shah, Sean P. Cleary, Jensen C. C. Tan, Alice C. Wei, Steve Gallinger, David R. Grant & Paul D. Greig

Authors
  1. Shimul A. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sean P. Cleary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jensen C. C. Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alice C. Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steve Gallinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David R. Grant
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul D. Greig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shimul A. Shah.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shah, S.A., Cleary, S.P., Tan, J.C.C. et al. An Analysis of Resection vs Transplantation for Early Hepatocellular Carcinoma: Defining the Optimal Therapy at a Single Institution. Ann Surg Oncol 14, 2608–2614 (2007). https://doi.org/10.1245/s10434-007-9443-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-007-9443-3

Keywords

Search

Navigation