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Is Resection or Transplantation the ideal Treatment in Patients with Hepatocellular Carcinoma in Cirrhosis if Both Are Possible? A Systematic Review and Metaanalysis

Annals of Surgical Oncology volume 21, pages 3096–3107 (2014)Cite this article

Abstract

Background

Hepatocellular carcinoma (HCC) is one of the most common neoplasms. Curative treatment options include liver resection (LR) and transplantation (LT). Organ shortage leads to discussion whether resectable HCC in cirrhosis should undergo LT or LR.

Methods

Systematic review and metaanalysis of studies investigating LR and/or LT were performed. Overall survival (OS) and disease-free survival (DFS) were analyzed. Studies reporting 5-year OS of LR versus LT in an intention-to-treat fashion were included in a metaanalysis.

Results

No randomized controlled trial was detected. Seventy publications were eligible for analysis. The 5-year OS revealed a better outcome for LT than LR (60.9 vs. 49.4 %; p < 0.001). Descriptive DFS data indicate superiority of LT at 3 years (62.0 vs. 45.9 %; p < 0.001) and 5 years (58 vs. 33.9 %; p < 0.001). Comparing the 5-year OS of transplantation and resection in a metaanalysis by use of the seven studies with a total of 1,572 patients, no survival advantage could be found (odds ratio, 0.84; 95 % confidence interval, 0.48–1.48; p = 0.55).

Conclusions

A low quality of evidence data suggests the following: resectable HCC should primarily be resected as good alternative to liver transplantation in patients in whom both seem feasible. Randomized controlled trials or at least systematic evaluation of a cohort of patients in which resection and transplantation seem possible should be performed in a registry. This analysis should include intention-to-treat analysis of patients on the waiting list who do not proceed to a potential curative treatment.

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Affiliations

  1. Department of Surgery, Regensburg University Hospital, Regensburg, Germany

    Andrea Proneth MD, Hans J. Schlitt MD, FACS & Andreas A. Schnitzbauer MD

  2. Center for Clinical Studies, Regensburg University Hospital, Regensburg, Germany

    Florian Zeman MSc

  3. Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany

    Andreas A. Schnitzbauer MD

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  1. Andrea Proneth MD
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  2. Florian Zeman MSc
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Correspondence to Andreas A. Schnitzbauer MD.

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Proneth, A., Zeman, F., Schlitt, H.J. et al. Is Resection or Transplantation the ideal Treatment in Patients with Hepatocellular Carcinoma in Cirrhosis if Both Are Possible? A Systematic Review and Metaanalysis . Ann Surg Oncol 21, 3096–3107 (2014). https://doi.org/10.1245/s10434-014-3808-1

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Keywords

  • Overall Survival
  • Liver Resection
  • Primary Biliary Cirrhosis
  • Milan Criterion
  • Good Overall Survival