American Surgical Association

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Is Surgical Resection Superior to Transplantation in the Treatment of Hepatocellular Carcinoma?
Leonidas G Koniaris, MD*, David M. Levi, MD*, Felipe Pedroso, MD*, Dido Franceschi, MD*, Alan S. Livingstone, MD, Andreas G. Tzakis, MD, Navine L. Solomon, MD*, Subhasis Misra, MD*, Teresa A. Zimmers, MD*
University of Miami, Miami, FL

OBJECTIVE(S):
To compare outcomes for patients with hepatocellular carcinoma (HCC) treated with either liver resection or transplantation.
METHODS:
A retrospective, single institution analysis of 415 HCC patients from 1999-2009.
RESULTS:
415 patients with HCC underwent surgical resection (n=109), transplantation (n=270), or were listed without receiving transplantation (n=36). Excluding transplanted patients with incidental tumors (n=50), 256 patients with suspected HCC were listed with the intent to transplant (ITT). The median diameter of the largest tumor by radiography was 5.0cm in resected, 2.8cm in transplanted, and 3.0cm in the listed-but-not-transplanted patients. Median time to transplant was 48 days. Recurrence rates were 17.4% for resection and 12.6% for all transplant patients. Overall, patient survival for resection vs. ITT patients was similar (5-year survival of 53.0% vs. 52.0%, NS). However, for HCC patients with MELD scores <10 and who radiologically met Milan or UCSF criteria, 1-year and 5-year survival rates were significantly better in resected patients. For patients with MELD <10 and who met Milan criteria, 1-year and 5-year survival was 92.0% and 63.0% for resection (n=26) vs. 83.0% and 41.0% for ITT (n=93, p=0.036). For those with MELD <10 and UCSF criteria, 1-year and 5-year survival was 94.0% and 62.0% for resection (n=33) vs. 81.0% and 40.0% for ITT (n=101, p=0.027).
CONCLUSIONS:
Among known HCC patients who were potential candidates for either resection or transplantation, resection was associated with superior patient survival. Surgical resection should remain the first line therapy for patients with HCC and compensated liver function who are candidates for resection.


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