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[Hepatocellular carcinoma: resection versus transplantation]
D Uhlmann1, H Witzigmann, F Geissler
1Chirurgische Klinik II-Klinik für Abdominal-, Transplantations- und Gefässchirurgie, Universität Leipzig. Uhld@medizin.uni-leipzig.de
Zentralblatt Fur Chirurgie
|August 29, 2000
Summary
Differentiating hepatocellular carcinoma (HCC) in cirrhotic versus non-cirrhotic livers is crucial for treatment decisions. Liver transplantation offers better survival rates for select HCC patients with cirrhosis compared to resection.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Transplant Surgery
Background:
- Accurate differentiation of hepatocellular carcinoma (HCC) in cirrhotic and non-cirrhotic livers is essential for determining optimal surgical therapy and comparing outcomes.
- Liver resection is the primary treatment for HCC in non-cirrhotic livers.
- The optimal surgical approach for HCC in cirrhotic livers remains a complex issue with varying outcomes.
Purpose of the Study:
- To compare the efficacy of subtotal hepatic resection and orthotopic liver transplantation for treating hepatocellular carcinoma.
- To evaluate survival rates and recurrence in patients with HCC undergoing different surgical interventions.
- To provide insights into the selection criteria for liver transplantation in HCC patients with cirrhosis.
Main Methods:
- A cohort of 54 patients with HCC were treated between April 1994 and August 1999.
- Treatment modalities included subtotal hepatic resection (n=40) and orthotopic liver transplantation (n=14).
- Survival rates and recurrence data were analyzed retrospectively.
Main Results:
- The resection group showed 1- and 3-year survival rates of 45% and 25%, respectively (median follow-up: 3.5 years).
- The transplantation group achieved a 1-year survival rate of 72% (median follow-up: 2.2 years).
- For HCC in cirrhosis (UICC stage I-III), liver resection resulted in poor outcomes (3-year recurrence-free survival: 30%), while literature suggests better outcomes (60-80% 3-year survival) with liver transplantation for small, early-stage tumors, necessitating careful patient selection.
Conclusions:
- Liver transplantation demonstrates superior survival rates compared to resection for carefully selected HCC patients with underlying cirrhosis.
- Resection in cirrhotic livers is associated with high operative mortality and recurrence.
- Liver transplantation is the preferred treatment for small HCCs in cirrhotic livers, but donor organ limitations restrict its use in advanced tumors.