Hepatocellular carcinoma: resection versus transplantation

Area of Science:

• Hepatobiliary Surgery
• Transplant Oncology
• Hepatocellular Carcinoma Research

Background:

• Hepatic resection and liver transplantation are standard curative treatments for hepatocellular carcinoma (HCC).
• Treatment selection is constrained by tumor stage and liver function.
• Optimal strategy for early-stage HCC with preserved liver function and no portal hypertension is debated.

Purpose of the Study:

• To evaluate the optimal treatment strategy for early-stage hepatocellular carcinoma in patients with well-preserved liver function.
• To compare disease-free and overall survival outcomes between hepatic resection and liver transplantation for HCC.

Main Methods:

• Review of retrospective studies and intention-to-treat survival analyses.
• Consideration of factors influencing treatment decisions, including tumor stage, liver disease severity, comorbidities, and transplant availability.

Main Results:

• Transplantation shows better disease-free survival for HCC recurrence post-resection.
• Overall survival benefits of transplantation are less clear, potentially due to post-resection therapies and post-transplant recurrence.
• Intention-to-treat analyses suggest comparable overall survival rates despite higher recurrence after resection.

Conclusions:

• Individualized treatment decisions for early-stage HCC require balancing tumor factors, liver status, comorbidities, and transplant logistics.
• While transplantation may offer long-term survival advantages, evolving adjuvant therapies may narrow the gap with resection.