Comparison of hepatic resection and hepatic transplantation in the treatment of hepatocellular carcinoma among cirrhotic patients.
BACKGROUND
The benefits of hepatic transplantation (HT) compared with hepatic resection (HR) in treating hepatocellular carcinoma (HCC) in patients with cirrhosis are controversial. The aim of this study was to compare the results of these therapeutic options.


METHODS
The charts of all patients with cirrhosis who underwent HR or HT for HCC between 1997 and 2000 were analyzed.


RESULTS
The cohort included 44 patients who underwent HR compared with 65 with HT. All patients in the HR group had Child's A disease, in contrast to the HT group, which included 23% Child's A and 77% Child's B and C patients. Whereas all HT patients spent at least three nights in the intensive care unit, 41% of the HR group never required critical care. Perioperative mortality was 7% in both groups. Pathologic analysis revealed T1/T2 disease in 43% of the HR group compared with 75% of the HT group. After 36 months of follow-up, there was no significant difference in overall survival (57% vs. 66%) or disease-free survival (36% vs. 66%) between the two groups.


CONCLUSIONS
With overall survival and disease-free survival as the main outcomes, the results of HR versus HT are comparable in Child's A patients with HCC. In this patient subset, HR not only is an effective form of therapy, but is also associated with quicker recovery.
Shabahang
Mohsen
M
Department of Surgery, University of Miami School of Medicine, Miami, Florida, USA. mshabahang@swmail.sw.org
Franceschi
Dido
D
Yamashiki
Noriyo
N
Reddy
Raj
R
Pappas
Peter A
PA
Aviles
Kuky
K
Flores
Sonia
S
Chaparro
Andrea
A
Levi
Joseph U
JU
Sleeman
Danny
D
Tzakis
Andreas G
AG
Kato
Tomoaki
T
Levi
David M
DM
Livingstone
Alan S
AS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002648:Child; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis