Skip to main content
SpringerLink
Log in

Role of liver transplantation in the treatment of unresectable liver cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Resection remains the treatment of choice in liver cancer. In order to avoid liver transplantation in conventionally unresectable tumors ex-situ (“bench” procedure), in-situ and ante-situm resection technique should be prefered whenever feasible. Despite the deficiency of donor organs, a single center experience with 198 patients reveals that liver transplantation continues its role as a therapeutic option for selected patients. At present “favorable” indications for transplantation are International Union against Cancer (UICC)-stage II hepatocellular carcinoma as well as the subtype fibrolamellar carcinoma, uncommon tumors such as epitheloid hemangioendothelioma, hepatoblastoma, and liver metastases from neuroendocrine tumors. Due to unsatisfying results, intrahepatic bile duct-, stage III and IV hepatocellular carcinoma, hemangiosarcoma, and liver metastases from nonendocrine primaries should be excluded from liver transplantation alone. For these advanced tumors, especially in cases of extrahepatic involvement, a combination of liver transplantation and multivisceral resection has been proven feasible. However, a significant improvement in patient survival may only be expected by currently investigated multimodality treatment protocols which will require further randomized studies.

Résumé

La résection reste le traitement de choix des cancers du foie. Chez le patient ayant un carcinome estimé non résécable par des techniques traditionnelles, on a recours à des techniques ex-situ («bench» procédure), in-situ et ante-situm, chaque fois que possible. En dépit du manque de donneurs dans un centre qui compte actuellement 198 patients, la transplantation garde une place chez certains de ces patients. A présent, les indications sont des carcinomes hépatocellulaires de stade II selon l'UICC, les carcinomes fibro-lamellaires, et d'autres tumeurs plus rares telles que l'hémangioendothéliome, l'hépatoblastome et des métastases provenant des tumeurs neuroendocrines. En raison des résultats peu satisfaisants, on exclut les carcinomes stades III et IV, les cancers biliaires intrahépatiques, les hémangiosarcomes et les métastases en rapport avec des tumeurs non endocrines. En cas de tumeur avancée avec un envahissement extrahépatique, on peut parfois combiner la transplantation avec une résection multiorgane. Une amélioration de la survie, cependant, ne peut provenir que des thérapeutiques multidisciplinaires, qui doivent être évaluées par des essais randomisés.

Resumen

La resección sigue siendo el tratamiento de preferencia en el cáncer del hígado. Con el objeto de evitar trasplante ex situ (procedimiento de “mesa”) de hígado en tumores convencionalmente no resecables, se debe preferir la técnica de resección in-situ y ante-situm siempre que sea posible. A pesar de la insuficiencia de órganos donantes, la experiencia de un solo centro con 198 pacientes revela que el trasplante de hígado mantiene su papel como una opción terapéutica real en pacientes seleccionados. En el momento actual las indicaciones “favorables” son el carcinoma hepatocelular en estado II de la Unión Internacional Contra el Cáncer (UICC), así como el carcinoma de subtipo fibrolamelar y, además, tumores muy poco frecuentes tales como el hemangioendotelioma epiteloide, el hepatoblastoma y las metástasis hepáticas de tumores neuroendocrinos. Debido a resultados poco satisfactorios en los carcinomas hepatocelulares en estados III y IV de los canales biliares intrahepáticos, del hemangiosarcoma y de las metástasis hepáticas de tumores primarios no endocrinos, éstos deben ser excluidos del trasplante. Para tales tumores avanzados, especialmente en el caso de extensión extrahepática, se ha comprobado la factibilidad de la combinación del trasplante de hígado con la resección multivisceral. Sin embargo, sólo se puede esperar una mejoría significativa de la supervivencia mediante los protocolos multimodales de tratamiento, los cuales requieren estudios randomizados adicionales.

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

Similar content being viewed by others

References

  1. Hermanek, P., Sobin, L.H.: TNM classification of malignant tumors, 4th ed. 2nd rev. Berlin, Springer-Verlag, 1992

    Google Scholar 

  2. Farmer, D.G., Rosove, M.H., Shaked, A., Busuttil, R.W.: Current treatment modalities for hepatocellular carcinoma. Ann. Surg. 219: 236, 1994

    Google Scholar 

  3. Kawarada, Y., Ito, F., Sakurai, H., Tanigawa, K., Iwata, M., Imai, T., Yokoi, H., Noguchi, T., Mizumoto, R.: Surgical treatment of hepato-cellular carcinoma. Cancer Chemother. Pharmacol. 33 (Suppl):S12, 1994

    Google Scholar 

  4. Kim, S.T., Kim, K.P.: Hepatic resection for primary liver cancer. Cancer Chemother. Pharmacol. 33 (Suppl):S18, 1994

    Google Scholar 

  5. Langer, B., Greig, P.D., Taylor, B.R.: Surgical resection and transplantation for hepatocellular carcinoma. Cancer Treat. Res. 69:231, 1994

    Google Scholar 

  6. Pichlmayr, R., Lamesch, P., Weimann, A., Ringe, B.: Surgical treatment of cholangiocellular carcinoma. World J. Surg. 19:83, 1995

    Google Scholar 

  7. Scheele, J., Stangl, R., Altendorf-Hofmann, A., Paul, M.: Resection of colorectal liver metastases. World J. Surg. 19:59, 1995

    Google Scholar 

  8. Tsao, J.I., Loftus, J.P., Nagorney, D.M., Adson, M.A., Ilstrup, D.M.: Trends in morbidity and mortality of hepatic resection for malignancy. Ann. Surg. 220:199, 1994

    Google Scholar 

  9. Huguet, C., Gavelli, A., Bona, S.: Hepatic resection with ischemia of the liver exceeding one hour. J. Am. Coll. Surg. 178:454, 1994

    Google Scholar 

  10. Jeng, K.S., Chen, B.F., Lin, H.J.: En bloc resection for extensive hepatocellular carcinoma. Is it advisable? World J. Surg. 18:834, 1994

    Google Scholar 

  11. Pichlmayr, R., Weimann, A., Lamesch, P., Ringe, B.: Liver transplantation for hepatocellular carcinoma and additional reference to bench surgery. J. Hep. Bil. Pancr. Surg. 2:133, 1994

    Google Scholar 

  12. Tang, Z.Y., You, Y.Q., Zhou, X.D., Yang, B.H., Ma Z.C., Lin, Z.Y.: Subclinical hepatocellular carcinoma: an analysis of 391 patients. J. Surg. Oncol. (Suppl.)3:55, 1993

    Google Scholar 

  13. Dalgic, A., Mirza, D.F., Gunson, B.K., D'Silva, M., Mayer, A.D., Buckels, J.A.C., McMaster, P.: Role of total hepatectomy and transplantation in hepatocellular carcinoma. Transpl. Proc. 26:3564, 1994

    Google Scholar 

  14. Pichlmayr, R., Weimann, A., Ringe, B.: Indications for liver transplantation in hepatobiliary malignancy. Hepatology 20:33S, 1994

  15. Ringe, B., Wittekind, C., Bechstein, W.O., Bunzendahl, H., Pichlmayr, R.: The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis with special regard to tumor stage and recurrence. Ann. Surg. 209:88, 1989

    Google Scholar 

  16. 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. 15:270, 1991

    Google Scholar 

  17. Funovics, J.M., Fritsch, A., Herbst, F., Piza, F., Mühlbacher, F., Längle, F., Schmeper, M.: Primary hepatic cancer—the role of limited resection and total hepatectomy with orthotopic liver replacement. Hepatogastroenterology 35:316, 1988

    Google Scholar 

  18. O'Grady, J.G., Polson, R.J., Rolles, K., Calne, R.Y., Williams, R.: Liver transplantation for malignant disease. Results in 93 consecutive patients. Ann. Surg. 207:373, 1988

    Google Scholar 

  19. Olthoff, K., Millis, M., Rosove, M.H., Goldstein, L.I., Ramming, K.P., Busuttil, R.W.: Is liver transplantation justified for the treatment of hepatic malignancies? Arch. Surg. 125:1261, 1990

    Google Scholar 

  20. Pichlmayr, R., Weimann, A., Steinhoff, G., Ringe, B.: Liver transplantation for hepatocellular carcinoma: clinical results and future aspects. Cancer Chemother. Pharmacol. 31 (Suppl 1):S157, 1992

    Google Scholar 

  21. Haug, C.E., Jenkins, R.L., Rohrer, R.J., Auchincloss, H., Delmonico, F.L., Freeman, R.B., Lewis, W.D., Cosimi, A.B.: Liver transplantation for primary hepatic cancer. Transplantation 53:376, 1992

    Google Scholar 

  22. Moreno-Gonzalez, E.M., Gomez, R., Garcia, I., Gonzalez-Pinto, I., Loinaz, C., Ibanez, J., Bercedo, J., Palomo, J.C., Palma, F., Vorwald, P., Riano, D., Perez Cerda, F., Davila, P., Cisneros, C., Maffettone, V., Sciadini, M.: Liver transplantation in malignant hepatic neoplasms. Am. J. Surg. 163:395, 1992

    Google Scholar 

  23. Bismuth, H., Chiche, L., Adam, R., Castaing, D., Diamond, T., Dennison, A.: Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann. Surg. 218:145, 1993

    Google Scholar 

  24. Chung, S.W., Toth, J.L., Rezieg, M., Cameron, R., Taylor, B.R., Greig, P.D., Levy, G.A., Langer, B.: Liver transplantation for hepatocellular carcinoma. Am. J. Surg. 167:317, 1994

    Google Scholar 

  25. Selby, R., Kadry, Z., Carr, B., Tzakis, A., Madariaga, J.R., Iwatsuki, S.: Liver transplantation for hepatocellular carcinoma. World J. Surg. 19:53, 1990

    Google Scholar 

  26. Yokoyama, I., Todo, S., Iwatsuki, S., Starzl, T.E.: Liver transplantation in the treatment of primary liver cancer. Hepatogastroenterology 37:188, 1990

    Google Scholar 

  27. Ismail, T., Angrisani, L., Gunson, B.K., Hübscher, S.G., Buckels, J.A.C., Neuberger, J.M., Elias, E., McMaster, P.: Primary hepatic malignancy: the role of liver transplantation. Br. J. Surg. 77:983, 1990

    Google Scholar 

  28. Penn, I.: Hepatic transplantation for primary and metastatic cancers of the liver. Surgery 110:726, 1991

    Google Scholar 

  29. Makowka, L., Tzakis, A.G., Mazzaferro, V., Teperman, L., Demetris, J., Iwatsuki, S., Starzl, T.E.: Transplantation of the liver for metastatic endocrine tumors of the intestine and pancreas. Surg. Gynecol. Obstet. 168:107, 1989

    Google Scholar 

  30. Ringe, B. Weimann, A., Lamesch, P., Nashan, B., Pichlmayr, R.: Liver transplantation as an option in patients with hepatocellular and bile duct carcinoma. Cancer Treat. Res. 69:259, 1994

    Google Scholar 

  31. Ringe, B., Wittekind, C., Weimann, A., Tusch, G., Pichlmayr, R.: Results of hepatic resection and transplantation for fibrolamellar carcinoma. Surg. Gynecol. Obstet. 175:299, 1992

    Google Scholar 

  32. Yokoyama, I., Carr, B., Saitsu, H., Iwatsuki, S., Starzl, T.E.: Accelerated growth rates of recurrent hepatocellular carcinoma after liver transplantation. Cancer 68:2095, 1991

    Google Scholar 

  33. Pichlmayr, R., Grosse, H., Hauss, J., Gubernatis, G., Lamesch, P., Bretschneider, H.J.: Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery of the in situ perfused liver. Br. J. Surg. 77:21, 1990

    Google Scholar 

  34. Kumada, K., Yamaoka, Y., Morimoto, T., Tanaka, K., Moriyasu, F., Yamaguchi, T., Mori, K., Tanaka, A., Ozawa, K.: Partial autotransplantation of the liver in hepatocellular carcinoma complicating cirrhosis. Br. J. Surg. 79:566, 1992

    Google Scholar 

  35. Iwatsuki, S., Starzl, T.E., Sheahan, D.G., Yokoyama, I., Demetris, A.J., Todo, S., Tzakis, A.G., Van Thiel, D.H., Carr, B., Selby, R., Madariaga, J.: Hepatic resection versus transplantation for hepatocellular carcinoma. Ann. Surg. 214:221, 1991

    Google Scholar 

  36. Bronowicki, J.P., Nisand, G., Alticri, M., Wenger, J.J., Uhl, G., Jaeck, D., Boissel, P., Bigard, M.A., Gaucher, P., Vetter D., Doffoel, M.: Compared results of resection (RX), orthotopic liver transplantation (OLT), and transcatheter oily chemoembolization (TOCE) in the treatment of Okuda's stage I hepatocellular carcinoma (HCC). Gastroenterology 104(Suppl):A881, 1993

  37. Starzl, T.E., Todo, S., Tzakis, A., Podesta, L., Mieles, L., Demetris, A., Teperman, L., Selby, R., Stevenson, W., Stieber, A., Gordon, R., Iwatsuki, S.: Abdominal organ cluster transplantation for the treatment of upper abdominal malignancies. Ann. Surg. 210:347, 1989

    Google Scholar 

  38. Alessiani, M., Tzakis, A., Todo, S., Demetris, A.J., Fung, J.J., Starzl, T.E.: Assessment of five-year experience with abdominal organ cluster transplantation. J. Am. Coll. Surg. 180:1, 1995

    Google Scholar 

  39. McMaster, P., Mirza, D., Harrison, J.D.: Surgical options for primary hepatocellular carcinoma. Br. J. Surg. 80:1365, 1993

    Google Scholar 

  40. Tang, Z.Y., Yu, Y.Q., Zhou, X.D., Ma, Z.C., Yang, B.H., Lin, Z.Y., Lu, J.Z., Liu, K.D., Fan, Z., Zeng, Z.C.: Treatment of unresectable primary liver cancer: with reference to cytoreduction and sequential resection. World J. Surg. 19:47, 1995

    Google Scholar 

  41. Spreafico, C., Marchiano, A., Regalia, E., Frigerio, L.F., Garbagnati, F., Andreola, S., Milella, M., Lanocita, R., Mazzaferro, V.: Chemoembolization of hepatocellular carcinoma in patients who undergo liver transplantation. Radiology 192:687, 1994

    Google Scholar 

  42. Trosi, R., Praet, M., Defreyne, L., Elewaut, A., Hesse, U.J., Pattyn, J., Decruyenaere, J., De Hemptinne, B.: Liver transplantation for hepatocellular carcinoma: the initial experience and a preliminary report from the university of Ghent, Belgium. Transpl. Proc. 26:3570, 1994

    Google Scholar 

  43. Broughan, T.A., Esquivel, C.O., Vogt, D.P., Griffin, G.C., Norris, D.G.: Pretransplant chemotherapy in pediatric hepatocellular carcinoma. J. Ped. Surg. 29:1319, 1994

    Google Scholar 

  44. Carr, B.I., Selby, R., Madariaga, J., Iwatsuki, S., Starzl, T.E.: Prolonged survival after liver transplantation and cancer chemotherapy for advanced-stage hepatocellular carcinoma. Transpl. Proc. 25:1128, 1993

    Google Scholar 

  45. Cherqui, D., Piedbois, P., Pierga, J.Y., Vavasseur, D., Tran Van-Nhieu, J., LeBourgeois, J.P., Julien, M., Fagniez, P.L., Dhumeaux, D.: Multimodal adjuvant treatment and liver transplantation for advanced hepatocellular carcinoma. A pilot study. Cancer 73:2721, 1994

    Google Scholar 

  46. Stone, M.J., Goran, B.G., Klintmalm G., Polter, D., Husberg, B.S., Mennel, R.G., Ramsy, M.A.E., Flemens, E.E., Goldstein, R.M.: Neoadjuvant chemotherapy and liver transplantation for hepatocellular carcinoma: a pilot study in 20 patients. Gastroenterology 104:196, 1993

    Google Scholar 

  47. Rizzi, P.M., Ryder, S.D., Ramage, J.K., Gane, E., Karani, J., Heaton, N., Portman, B., Tan, K.C., Williams, R.: Neoadjuvant chemotherapy after liver transplantation for hepatocellular carcinoma. Transpl. Proc. 26:3568, 1994

    Google Scholar 

  48. Raoul, J.L., Guyader, D., Bretagne, J.F., Duvauferrier, R., Bourguet, P., Bekhechi, D., Deugnier, Y.M., Gosselin, M.: Randomized controlled trial for hepatocellular carcinoma with portal vein thrombosis: Intra-arterial iodine-131-iodized oil versus medical support. J. Nucl. Med. 35:1782, 1994

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Strasse 8, 30625, Hannover, Germany

    Rudolf Pichlmayr M.D., Arved Weimann M.D., Karl J. Oldhafer M.D., Hans J. Schlitt M.D., Jürgen Klempnauer M.D., Hauke Lang M.D. & Günter Tusch M.S.

  2. Abteilung Anästhesie I, Medizinische Hochschule Hannover, Konstanty-Gutschow Strasse 8, 30625, Hannover, Germany

    Albrecht Bornscheuer M.D.

  3. Abteilung Hämatologie und Onkologie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Strasse 8, 30625, Hannover, Germany

    Ajay Chavan M.D.

  4. Abteilung Diagnostiche Radiologie I, Medizinische Hochschule Hannover, Konstanty-Gutschow-Strasse 8, 30625, Hannover, Germany

    Ekkehard Schmoll M.D.

  5. Abteilung Transplantationschirurgie, Georg-August-Universität, Robert-Koch-Strasse 40, 37075, Göttingen, Germany

    Burckhardt Ringe M.D.

Authors
  1. Rudolf Pichlmayr M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arved Weimann M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karl J. Oldhafer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hans J. Schlitt M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jürgen Klempnauer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Albrecht Bornscheuer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ajay Chavan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ekkehard Schmoll M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hauke Lang M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Günter Tusch M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Burckhardt Ringe M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pichlmayr, R., Weimann, A., Oldhafer, K.J. et al. Role of liver transplantation in the treatment of unresectable liver cancer. World J. Surg. 19, 807–813 (1995). https://doi.org/10.1007/BF00299775

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00299775

Keywords

Search

Navigation