IngentaConnect An Analysis of Resection vs Transplantation for Early Hepatocellu...

Authors: Shah, Shimul¹; Cleary, Sean; Tan, Jensen; Wei, Alice; Gallinger, Steve; Grant, David; Greig, Paul

Source: Annals of Surgical Oncology, Volume 14, Number 9, September 2007 , pp. 2608-2614(7)

Publisher: Springer

Abstract:

The reported survival after liver transplantation (OLT) for early hepatocellular carcinoma (HCC) is superior to the results of liver resection (LR), but few analyses have considered long waiting times and patient drop-offs due to tumor progression.

From 1995-2005, 347 patients with HCC were evaluated at our institution and underwent either LR (n = 174) or placed on the OLT waiting list (n = 173). Patients who only underwent ablation were not included. After eliminating patients with 1) incidental tumors after OLT, 2) tumors outside of Milan criteria, 3) preoperative vascular invasion prior to LR and 4) Child-Pugh Class C cirrhosis prior to OLT, 261 patients (LR = 121; OLT = 140) were included in this analysis.

Median follow-up time was 35 months. Median waiting time for OLT was 7.7 months; during this time, 30 patients were taken off the waiting list. Overall survival (OS) from time of listing or LR was not different between the two groups; 1, 3, and 5 year OS after LR was 89%, 75%, and 56% compared with 90%, 70%, and 64% for OLT (P = .84). Only patients who waited <4 months for OLT (n = 67) had better survival than those who underwent LR (P = .05). Patients who waited longer that four months for OLT had a 2.5× higher risk of death in a Cox multivariate model [odds ratio (OR) 2.5; 95% confidence interval (CI): 1.3-5; P = .007].

Unless waiting time is short (<4 months), the survival of patients with early HCC is similar between LR and LT.

Keywords: Hepatocellular carcinoma; Resection; Transplantation; Waiting time; MELD; Vascular invasion; Milan criteria

Document Type: Research article

DOI: 10.1245/s10434-007-9443-3

Affiliations: 1: Email: shahs01@ummhc.org

The full text electronic article is available for purchase. You will be able to download the full text electronic article after payment.

$47.00 plus tax Refund Policy

An Analysis of Resection vs Transplantation for Early Hepatocellular Carcinoma: Defining the Optimal Therapy at a Single Institution