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01-10-2008 | 2008 ssat plenary presentation

Surgical Management of Early-Stage Hepatocellular Carcinoma: Resection or Transplantation?

Authors: Emily C. Bellavance, Kimberly M. Lumpkins, Gilles Mentha, Hugo P. Marques, Lorenzo Capussotti, Carlo Pulitano, Pietro Majno, Paulo Mira, Laura Rubbia-Brandt, Alessandro Ferrero, Luca Aldrighetti, Steven Cunningham, Nadia Russolillo, Benjamin Philosophe, Eduardo Barroso, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 10/2008

Abstract

Background

The surgical management of hepatocellular carcinoma in patients with well-compensated cirrhosis is controversial. The purpose of the current study was to compare the outcome of patients with well-compensated cirrhosis and early stage hepatocellular carcinoma treated with initial hepatic resection versus transplantation.

Methods

Between 1985 and 2008, 245 patients underwent hepatic resection, and 134 patients underwent liver transplantation for early stage hepatocellular carcinoma. All patients had well-compensated cirrhosis. Prognostic factors were evaluated using univariate and multivariate analyses; survival was calculated using the Kaplan–Meier method.

Results

Compared with transplantation, patients undergoing resection had larger tumors and a higher incidence of microscopic vascular invasion. Transplantation was associated with better 5-year disease-free and overall survival compared with resection. Hepatitis status, presence of microscopic vascular invasion, and tumor size were predictors for recurrence, while the presence of microscopic vascular invasion and tumor size conferred an increased risk of death. The disease-free survival advantage with transplantation was more pronounced in hepatitis C patients compared with non-hepatitis and hepatitis B patients. The overall survival advantage with transplantation persisted in cases of solitary lesions ≤3 cm, but was attenuated in patients with a MELD score ≤ 8.

Conclusion

In well-compensated cirrhotic patients with early stage hepatocellular carcinoma, transplantation was associated with longer disease-free and overall survival. Patients undergoing resection did, however, have tumors with more advanced pathologic features. Patients best suited for initial resection as the treatment of hepatocellular carcinoma were those with a MELD score ≤ 8 without evidence of hepatitis.

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Title: Surgical Management of Early-Stage Hepatocellular Carcinoma: Resection or Transplantation?
Authors: Emily C. Bellavance
Kimberly M. Lumpkins
Gilles Mentha
Hugo P. Marques
Lorenzo Capussotti
Carlo Pulitano
Pietro Majno
Paulo Mira
Laura Rubbia-Brandt
Alessandro Ferrero
Luca Aldrighetti
Steven Cunningham
Nadia Russolillo
Benjamin Philosophe
Eduardo Barroso
Timothy M. Pawlik
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0652-2

At a glance: The STEP trials

Springer Medicine

Surgical Management of Early-Stage Hepatocellular Carcinoma: Resection or Transplantation?

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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