Hepatocellular carcinoma--resection or transplant?

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Transplant surgery

Background:

• Hepatocellular carcinoma (HCC) management involves surgical resection and liver transplantation, with optimal selection controversial due to limited randomized trial data.
• Current guidelines suggest liver transplantation for HCC with suboptimal liver function and resection for tumors within Milan criteria and preserved liver function.
• Tumors exceeding Milan criteria but within expanded criteria show better outcomes with transplantation compared to resection.

Approach:

• Comparative analysis of retrospective data to evaluate outcomes of resection versus liver transplantation for HCC.
• Assessment of treatment strategies based on tumor stage, Milan criteria, and liver function.
• Exploration of a combined approach: resection followed by transplantation upon recurrence.

Key Points:

• For early-stage HCC, liver transplantation is preferred in patients with poor liver function.
• Resection is favored for HCC within Milan criteria and preserved liver function, offering similar survival to transplantation.
• Transplantation demonstrates superior outcomes for HCC beyond Milan criteria but within expanded criteria.

Conclusions:

• Resection and liver transplantation are complementary treatments for hepatocellular carcinoma.
• A strategy of resection followed by transplantation for recurrence may optimize graft utilization and patient outcomes.
• Further investigation into expanding criteria for both resection and transplantation in HCC management is warranted.