Resection and liver transplantation for HCC

Area of Science:

• Hepatobiliary Surgery
• Transplant Surgery
• Surgical Oncology

Background:

• Liver transplantation (LT) was historically superior to resection for chronic liver disease with limited hepatocellular carcinoma (HCC).
• A persistent organ shortage for LT has led to prolonged waiting times, increasing tumor progression and recurrence risk.
• Surgical advances have improved the safety of liver resection, making it a viable option in specific scenarios.

Purpose of the Study:

• To evaluate the role of liver resection as a strategy for patients with hepatocellular carcinoma (HCC) eligible for liver transplantation (LT).
• To explore how resection can be integrated with LT to optimize outcomes amidst organ shortages.

Main Methods:

• Review of current surgical strategies and outcomes for HCC patients undergoing resection and/or LT.
• Analysis of the impact of prior resection on subsequent LT outcomes.
• Discussion of different clinical settings where resection can be employed before or as a bridge to LT.

Main Results:

• Prior liver resection does not increase morbidity or impair survival after deceased donor LT.
• Resection can serve as primary therapy, a method for patient selection, or a bridge to LT.
• Integrating resection and LT strategies is beneficial, rather than opposing them.

Conclusions:

• Resection should be considered an adjunct to LT for HCC patients, not an alternative.
• The optimal strategy depends on graft availability, waiting times, and center expertise.
• This integrated approach opens new avenues for managing HCC patients eligible for LT.