Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients.
Abstract
OBJECTIVE: Currently, there is considerable controversy about the place of transplantation in the treatment of hepatocellular carcinoma (HCC). This study compared resection to transplantation in cirrhotic patients with HCC in order to determine reasonable indications of each treatment. SUMMARY BACKGROUND DATA: The usual procedure is to resect when feasible and to transplant in other cases. METHODS: Three-year survival with and without recurrence was analyzed in 60 patients who underwent resection and 60 who underwent transplantation. Several prognostic factors, such as size, number of nodules, portal thrombus, and histologic form, were studied. RESULTS: In terms of overall survival rates, resection and transplantation yield the same results (50% vs. 47%, respectively, at 3 years). For transplantation, however, the rate for survival without recurrence is better than that for resection (46% vs. 27%, respectively; p < 0.05). In the case of small uninodular or binodular tumors (< 3 cm), transplantation has much better results than resection (survival without recurrence, 83% vs. 18%, respectively; p < 0.001). However, it seems that a group of patients with high risk of recurrence after transplantation can be determined (diffuse form, more than two nodules > 3 cm, or presence of portal thrombus). CONCLUSIONS: The best indication for transplantation seems to be patients with small and uninodular or binodular tumors; until now, these patients were considered to be the best candidates for resection. Patients undergoing transplantation for unresectable, large, multinodular or diffuse tumors seem to represent bad indications for transplantation. These results could help define reasonable indications for transplantation in an era with a shortage of liver grafts.
Full text
Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bismuth H, Houssin D, Ornowski J, Meriggi F. Liver resections in cirrhotic patients: a Western experience. World J Surg. 1986 Apr;10(2):311–317. [PubMed] [Google Scholar]
- Bismuth H, Morino M, Sherlock D, Castaing D, Miglietta C, Cauquil P, Roche A. Primary treatment of hepatocellular carcinoma by arterial chemoembolization. Am J Surg. 1992 Apr;163(4):387–394. [PubMed] [Google Scholar]
- Iwatsuki S, Starzl TE, Sheahan DG, Yokoyama I, Demetris AJ, Todo S, Tzakis AG, Van Thiel DH, Carr B, Selby R, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg. 1991 Sep;214(3):221–229.[PMC free article] [PubMed] [Google Scholar]
- Ringe B, Pichlmayr R, Wittekind C, Tusch G. Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg. 1991 Mar-Apr;15(2):270–285. [PubMed] [Google Scholar]
- Iwatsuki S, Gordon RD, Shaw BW, Jr, Starzl TE. Role of liver transplantation in cancer therapy. Ann Surg. 1985 Oct;202(4):401–407.[PMC free article] [PubMed] [Google Scholar]
- Bismuth H, Adam R, Mathur S, Sherlock D. Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era. Am J Surg. 1990 Jul;160(1):105–110. [PubMed] [Google Scholar]
- Nakashima T, Okuda K, Kojiro M, Jimi A, Yamaguchi R, Sakamoto K, Ikari T. Pathology of hepatocellular carcinoma in Japan. 232 Consecutive cases autopsied in ten years. Cancer. 1983 Mar 1;51(5):863–877. [PubMed] [Google Scholar]
- Bismuth H, Houssin D, Castaing D. Major and minor segmentectomies "réglées" in liver surgery. World J Surg. 1982 Jan;6(1):10–24. [PubMed] [Google Scholar]
- Castaing D, Garden OJ, Bismuth H. Segmental liver resection using ultrasound-guided selective portal venous occlusion. Ann Surg. 1989 Jul;210(1):20–23.[PMC free article] [PubMed] [Google Scholar]
- Bismuth H. Liver transplantation: the Paul Brousse experience. Transplant Proc. 1988 Feb;20(1 Suppl 1):486–489. [PubMed] [Google Scholar]
- O'Grady JG, Polson RJ, Rolles K, Calne RY, Williams R. Liver transplantation for malignant disease. Results in 93 consecutive patients. Ann Surg. 1988 Apr;207(4):373–379.[PMC free article] [PubMed] [Google Scholar]
- Ringe B, Wittekind C, Bechstein WO, Bunzendahl H, Pichlmayr R. The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis of 95 patients with particular regard to tumor stage and recurrence. Ann Surg. 1989 Jan;209(1):88–98.[PMC free article] [PubMed] [Google Scholar]
- Yuki K, Hirohashi S, Sakamoto M, Kanai T, Shimosato Y. Growth and spread of hepatocellular carcinoma. A review of 240 consecutive autopsy cases. Cancer. 1990 Nov 15;66(10):2174–2179. [PubMed] [Google Scholar]
- Okamoto E, Tanaka N, Yamanaka N, Toyosaka A. Results of surgical treatments of primary hepatocellular carcinoma: some aspects to improve long-term survival. World J Surg. 1984 Jun;8(3):360–366. [PubMed] [Google Scholar]
- Hsu HC, Chiou TJ, Chen JY, Lee CS, Lee PH, Peng SY. Clonality and clonal evolution of hepatocellular carcinoma with multiple nodules. Hepatology. 1991 May;13(5):923–928. [PubMed] [Google Scholar]
- Zhou XD, Tang ZY, Yu YQ, Ma ZC, Yang BH, Lu JZ, Lin ZY. Hepatocellular carcinoma: some aspects to improve long-term survival. J Surg Oncol. 1989 Aug;41(4):256–262. [PubMed] [Google Scholar]
- Ismail T, Angrisani L, Gunson BK, Hübscher SG, Buckels JA, Neuberger JM, Elias E, McMaster P. Primary hepatic malignancy: the role of liver transplantation. Br J Surg. 1990 Sep;77(9):983–987. [PubMed] [Google Scholar]
- Pichlmayr R, Ringe B, Lauchart W, Bechstein WO, Gubernatis G, Wagner E. Radical resection and liver grafting as the two main components of surgical strategy in the treatment of proximal bile duct cancer. World J Surg. 1988 Feb;12(1):68–77. [PubMed] [Google Scholar]