Liver transplantation for hepatocellular carcinoma?

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Transplantation Medicine

Background:

• Primary hepatic cancer presents significant treatment challenges globally.
• Surgical management options include hepatic resection and liver transplantation.
• Treatment decisions are influenced by tumor characteristics and patient-specific factors.

Purpose of the Study:

• To review global experiences with hepatic resection and liver transplantation for primary hepatic cancer.
• To present the advantages and disadvantages of both surgical approaches.
• To delineate the factors influencing the choice between resection and transplantation.

Main Methods:

• Comprehensive review of worldwide experience from major transplant programs.
• Analysis of pros and cons for both hepatic resection and liver transplantation.
• Evaluation of medical, surgical, and patient-related factors impacting treatment selection.

Main Results:

• Liver transplantation is favored for small neoplastic lesions (<5 cm, <=3 lesions), particularly in the context of cirrhosis.
• Hepatic resection is the preferred method for larger lesions or in patients without cirrhosis.
• Geographic location, financial resources, and surgical expertise are key determinants in treatment choice.

Conclusions:

• The optimal surgical strategy for primary hepatic cancer is multifactorial.
• Patient and tumor characteristics, alongside resource availability, guide the decision between resection and transplantation.
• Transplantation offers a viable option for specific early-stage liver cancer scenarios, while resection remains crucial for advanced disease.