[Surgical treatment of hepatocellular carcinoma. Long term results].
BACKGROUND
Surgical treatment for hepatocellular carcinoma remains controversial due to a lack of prospective randomized studies.


METHODS
Between January 1990 and December 2000, 121 liver transplantations (group 1) and 52 hepatectomies (group 2) were performed for hepatocellular carcinoma. Each surgical treatment was carried out depending on patients' and tumor's characteristics.


RESULTS
Patients from group 1 had a more advanced tumoral grade, with higher involvement of two lobes (19 vs 4%; p = 0.015) and higher number of nodules (1.9 DE [2] vs 1.2 [0.6]; p = 0.001); yet the mean tumor size was lower (3 cm [1.5] vs 4.2 [3.2]; p = 0.006). Operative mortality (4% vs 2%; p = 0.66) and 5- and 10-years survival (68% and 42% vs 63% and 45%; p = 0.23) were similar between both groups. Nevertheless, 5- and 10-years recurrence rates (10.6% and 10.6% vs 50% and 65.5%; p < 0.0001) were more favourable in group 1. Prognostic factors of recurrence included microscopic vascular invasion (RR = 12.12; CI, 2.02-75.52) and alpha-fetoprotein levels higher than 300 ng/mL (RR = 7.12; 95% CI, 1.08-47.02) in group 1, and the pT3-4 stage (RR = 3.86; 95% CI, 1.06-14.03) in group 2. Mean time on waiting lists for liver transplantation was 3.06 (2.66) months and it has increased significantly in last years, especially among blood group 0 patients. However, this fact has not been associated with a worsening of survival rates (p = 0.98).


CONCLUSIONS
After a good patient selection, either liver transplantation or hepatectomy achieve excellent long term survival rates in patients with hepatocellular carcinoma, though the former allows a better control of the tumoral disease. The increase of mean time on waiting lists for liver transplantation during the last years has not led to a worsening of survival results.
Figueras
Juan
J
Servicio de Cirugía General, Ciudad Sanitaria y Universitaria de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. jfgueras@csub.scs.es
Ramos
Emilio
E
Ibáñez
Luis
L
Valls
Carles
C
Serrano
Teresa
T
Rafecas
Antonio
A
Casanovas
Teresa
T
Fabregat
Juan
J
Xiol
Xavier
X
Torras
Jaume
J
Baliellas
Carmen
C
Jaurrieta
Eduardo
E
Casais
Luis
L
D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors
Resultados a largo plazo del tratamiento quirúrgico del hepatocarcinoma.