Superiority of Transplantation Versus Resection for the Treatment of Small Hepatocellular Carcinoma

• DOI: 10.1016/j.transproceed.2007.05.045
• Publication Date: 2007-08-09T11:38:50Z
• Authors: U. Baccarani; E. Benzoni; G.L. Adani; C. Avellini; D. Lorenzin; M. Sainz-Barriga; V. Bresadola; A. Uzzau; A. Risaliti; C.A. Beltrami; F. Bresadola
• Keywords: Adult; Male; Carcinoma, Hepatocellular; Time Factors; Liver Neoplasms; Middle Aged; Hepatitis B; Hepatitis C; Survival Analysis; Disease-Free Survival; Liver Transplantation; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Surgical Procedures, Operative; Humans; Female; Aged

The best therapy for hepatocellular carcinoma (HCC) is still debated. Hepatic resection (HR) is the treatment of choice for single HCC in Child A patients, whereas liver transplantation (OLT) is usually reserved for Child B and C patients with multiple nodules. The aim of this study was to compare HR and OLT for HCC within the Milan criteria on an intention-to-treat basis. Forty-eight patients were treated by OLT and 38 by HR. Three- and 5-year patient survival rates were significantly higher (P = .0057) in the OLT group (79% and 74%) than after HR (61% and 26%). The 3- and 5-year disease-free survival rate was better (P = .0005) for OLT (74% and 74%) versus HR (41% and 11%). The probability of HCC recurrences after resection was greater (P = .0002) than after transplantation, achieving 31% and 76% for HR and 2% and 2% for OLT at 3 and 5 years after surgery. The median waiting list time was 118 days; two patients dropped out for HCC progression. We concluded that OLT is superior to HR for small HCC in cirrhotic patients assuming that OLT can be performed within 6 to 10 months after listing to reduce dropouts due to tumor progression.