Medscape Article - Liver Transplantation for Recurrent Hepatocellular Carcinoma on Cirrhosis After Liver Resection

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http://www.medscape.com/viewarticle/580923 (there are 4 pages of this)

Liver Transplantation for Recurrent Hepatocellular Carcinoma on Cirrhosis After Liver Resection: University of Bologna Experience

Posted 10/10/2008

M. Del Gaudio; G. Ercolani; M. Ravaioli; M. Cescon; A. Lauro; M. Vivarelli; M. Zanello; A. Cucchetti; G. Vetrone; F. Tuci; G. Ramacciato; G. L. Grazi; A. D. Pinna

Abstract and Introduction

Abstract

Liver resection (LR) for patients with small hepatocellular carcinoma (HCC) with preserved liver function, employing liver transplantation (LT) as a salvage procedure (SLT) in the event of HCC recurrence, is a debated strategy.

From 1996 to 2005, we treated 227 cirrhotic patients with HCC transplantable: 80 LRs and 147 LTs of 293 listed for transplantation. Among 80 patients eligible for transplantation who underwent LR, 39 (49%) developed HCC recurrence and 12/39 (31%) of these patients presented HCC recurrence outside Milan criteria. Only 10 of the 39 patients underwent LT, a transplantation rate of 26% of patients with HCC recurrence.

According to intention-to-treat analysis of transplantable HCC patients who underwent LR (n = 80), compared to all those listed for transplantation (n = 293), 5-year overall survival was 66% in the LR group versus 58% in patients listed for LT, respectively (p = NS); 5-year disease-free survival was 41% in the LR group versus 54% in patients listed for LT (p = NS).

Comparable 5-year overall (62% vs. 73%, p = NS) and disease-free (48% vs. 71%, p = NS) survival rates were obtained for SLT and primary LT for HCC, respectively.

LR is a valid treatment for small HCC and in the event of recurrence, SLT is a safe and effective procedure.