Primary hepatic malignancies: resection or liver transplantation?

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Transplant Medicine

Background:

• Liver transplantation is a critical treatment option for specific liver malignancies.
• Prognosis for unresectable or infiltrating hepatocellular carcinoma (HCC) without transplantation is extremely poor.
• Cirrhosis often precludes major liver resection, necessitating alternative therapeutic strategies.

Purpose of the Study:

• To evaluate the efficacy of liver transplantation for potentially curable liver malignancies.
• To compare outcomes of liver transplantation versus conventional treatments for HCC in cirrhotic patients.
• To define the role of liver transplantation in managing advanced liver cancer.

Main Methods:

• Retrospective analysis of patient data including those with hepatocellular carcinoma (HCC) and other primary hepatic carcinomas.
• Comparison of survival rates between patients undergoing liver transplantation and those receiving non-curative or curative resection.
• Assessment of 1-year survival rates post-liver transplantation.

Main Results:

• Patients with unresectable HCC had a very poor prognosis without transplantation.
• Liver transplantation demonstrated a 1-year survival rate of 54% in patients with primary hepatic carcinomas (including HCC).
• For cirrhotic patients with large or infiltrating HCC, liver transplantation yielded better outcomes than resection in Western populations.

Conclusions:

• Liver transplantation should be strongly considered for cirrhotic patients with unresectable or large/infiltrating HCC.
• The scarcity of donor organs remains a significant limitation for liver transplantation.
• Transplantation is rarely indicated for metastatic liver disease.