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Resection Transplant in the Treatment of Primary Liver Cancers

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Image-Guided Cancer Therapy

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Abstract

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. Liver resection and orthotopic liver transplantation (OLT) for HCC are the most effective therapies which can achieve cure or long-term survival. Ideal candidates for liver resection are patients with compensated liver function (Child-Turcotte-Pugh [CTP] class A) and absence of portal hypertension. Portal vein embolization (PVE) and sequential use of transarterial chemoembolization (TACE) followed by PVE are adjunctive modalities to surgical resection which can be used for patient selection, making resection safer in cirrhotic patients. Although liver resection for HCC achieves a 5-year survival rate of 30–50 %, tumor recurrence is common affecting 70–80 % of patients. OLT has the advantage of simultaneous removal of tumor and diseased liver; however, this treatment can be offered only to a small proportion of patients due to tumor stage beyond accepted criteria and donor organ shortage. The Milan (single lesion ≤5 cm, or no more than three lesions ≤3 cm) and UCSF criteria (single lesion ≤6.5 cm, or no more than three lesions ≤4.5 cm and a total diameter of 8 cm) are the most widely accepted criteria defining the candidacy of patients with HCC for OLT. Whether liver resection or OLT should be used as primary therapy of patients with HCC within the Milan or UCSF criteria is hotly debated. While OLT is favored as primary therapy for small HCC in the United States, many European and Asian centers use primary liver resection with salvage transplantation for recurrence as favored treatment approach in patients with reasonable liver function (CTP class A) and absence of portal hypertension. Cirrhotic patients with small HCC who have decompensated liver function (CTP class B and C) and portal hypertension should be primarily considered for OLT.

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Authors and Affiliations

  1. Department of Transplant Surgery, Henry Ford Transplant Institute, 2799 W. Grand Boulevard, CFP-2, Detroit, MI, 48202, USA

    Gabriel Schnickel

  2. Swiss Hepato-Pancreato-Biliray and Transplant Center, Department of Surgery, University Hospital Zürich, Raemistrasse 100, Zürich, 8091, Switzerland

    Henrik Petrowsky

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  1. Gabriel Schnickel
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  2. Henrik Petrowsky
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Correspondence to Henrik Petrowsky .

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Editors and Affiliations

  1. The Warren Alpert Medical School of Brown University, Department of Diagnostic Imaging Rhode Island Hospital, Providence, Rhode Island, USA

    Damian E. Dupuy

  2. Department of Surgery and Radiology Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Yuman Fong

  3. McMullen Consulting, LLC, Surprise, Arizona, USA

    William N. McMullen

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Schnickel, G., Petrowsky, H. (2013). Resection Transplant in the Treatment of Primary Liver Cancers. In: Dupuy, D., Fong, Y., McMullen, W. (eds) Image-Guided Cancer Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0751-6_25

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