Surgical options in the treatment of hepatocellular carcinoma

In response to an increase in hepatitis C virus infection in the United States, we reviewed our experience with surgically treated hepatocellular carcinoma in an academic setting to assess the proper treatment protocol for patients who are amenable to surgical therapy. A chart review was conducted on all patients with a diagnosis of hepatocellular carcinoma and surgical therapy from 1990 to 2006 identified through the tumor registries at three university-affiliated institutions. Data on patient characteristics, tumor features, and complications were collected. Outcomes evaluated included recurrence and survival. One hundred three patients were identified; 44 underwent resection, 49 underwent transplantation, and 11 underwent radiofrequency ablation. Patients undergoing transplantation had more severe liver disease and less advanced tumors. Recurrence was lower in the transplant group. Survival in the resection group was 65 per cent, 28 per cent, and 24 per cent at 1, 3, and 5 years. Survival in the transplanted group was 83 per cent, 65 per cent, and 52 per cent at 1, 3, and 5 years. Transplantation offers better survival than resection for patients with hepatocellular carcinoma. Patients with stage I disease may be eligible for resection based on small tumor size and liver function; however, these patients should be considered for transplantation to improve their long-term survival.