Hepatoma of the liver--resection or transplantation?

Despite recent advances with techniques of in situ tumor ablation, surgical therapy remains at present the mainstay in the treatment of primary hepatic malignancies.

After an initial endeavor to establish liver transplantation as a treatment option, especially for unresectable liver tumors, only a few indications, for example early hepatocellular carcinoma in cirrhosis, are currently agreed upon. Other indications, such as peripheral cholangiocarcinoma and hepatocellular carcinoma in non-cirrhotics, have largely been abandoned or are still under debate, as with fibrolamellar carcinoma. Selection of patients suffering from hepatocellular carcinoma in cirrhosis for liver transplantation is still based on tumor size and node number, because the current state of diagnostic imaging fails to reliably predict the most important prognostic parameter: vascular infiltration. Other selection criteria are under investigation. Studies on multimodal therapy are also underway but have not yet demonstrated a benefit.