Annals of Surgery

Skip Navigation LinksHome > December 2012 - Volume 256 - Issue 6 > Resection or Transplantation for Early Hepatocellular Carcin...
Annals of Surgery:
doi: 10.1097/SLA.0b013e318273bad0
Feature

Resection or Transplantation for Early Hepatocellular Carcinoma in a Cirrhotic Liver: Does Size Define the Best Oncological Strategy?

Adam, Rene MD, PhD*,†,‡; Bhangui, Prashant MS*; Vibert, Eric MD*,†,‡; Azoulay, Daniel MD, PhD*,†,§; Pelletier, Gilles MD, PhD*; Duclos-Vallée, Jean-Charles MD, PhD*,†,‡; Samuel, Didier MD, PhD*,†,‡; Guettier, Catherine MD*; Castaing, Denis MD*,†,‡

Collapse Box

Abstract

Background: Resection and liver transplantation (LT) are the only curative options for hepatocellular carcinoma in cirrhotic patients (HCC-cirr).

Objective: We tried to define the best primary intention-to-treat strategy in patients undergoing either resection or LT for early single HCC-cirr (≤5 cm).

Methods: From 1990 to 2010, 198 patients with early HCC-cirr underwent either resection (group R, n = 97) or LT (group T, n = 101) as the primary procedure. Our policy was to prioritize Childs A patients with peripheral lesions for resection rather than LT. Patient and tumor characteristics, and outcomes (recurrence-free survival [RFS] and overall survival [OS]), were studied.

Results: A longer diagnosis-to-surgery interval, more Child Pugh B/C patients, and more tumor nodules (on histopathological examination) were found in group T patients. The postoperative mortality (4.1% vs 3.0%, P = 0.72) and rate of major complications (19.1% vs 24.7%, P = 0.35) were similar in groups R and T, respectively, whereas tumor recurrence was higher in group R (62% vs 10% in group T, P < 0.0001). The 5-year OS (75% vs 52%, P = 0.0008) and RFS (72% vs 20%, P < 0.0001) were better in group T; similarly, more patients were disease free at last follow-up (27% vs 62%, P < 0.0001). Resection as the surgical procedure, tumor diameter 3 cm or more on histology, and microvascular tumor invasion were poor prognostic factors for OS and RFS. Including dropout patients from LT list in the analysis, the outcomes in group T were still better (70% and 61% vs 51% and 36% at 5 and 10 years, P = 0.01).

Conclusions: On an intention-to-treat basis, LT is associated with the best survival outcomes in patients with early HCC-cirr. Resection may achieve comparable OS in patients with single HCC-cirr of size smaller than 3 cm; however, the RFS still remains lower than that in patients of group T. This study could serve as a guide for HCC-cirr patients who are candidates for either resection or LT.

© 2012 Lippincott Williams & Wilkins, Inc.

Login

Article Tools

Share

Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.