title: Resection and liver transplantation for hepatocellular carcinoma.
abstract: Surveillance programs in cirrhotic patients enable the detection of hepatocellular carcinoma (HCC) at early stages, when the tumor is amenable to curative treatments (60% of cases in Japan; 25 to 40% in Europe and the United States). Resection is the mainstay of treatment in noncirrhotic patients and in cirrhotics with well-preserved liver function. In modern series, a perioperative mortality < or = 3% and 5-year survival rates above 50% are expected. Tumor recurrence complicates half of the cases at 3 years, but there is no unquestionable preventive treatment. Liver transplantation provides excellent outcomes applying the Milan criteria (single nodule < or = 5 cm or two or three nodules < or = 3 cm), with 5-year survival rates of 70% and low recurrence rates. Although expansion of selection criteria is appealing, it should be assessed in the setting of prospective well-designed studies. Intention-to-treat analysis has shown that wide extended indications lead to 25% 5-year survival rates. Living donor liver transplantation is having a minor impact in HCC management. Molecular markers are needed to better select the candidates for surgery.
authors.affiliation: BCLC Group, Liver Unit, Digestive Disease Institute, IDIBAPS, Hospital Clínic, University of Barcelona, Catalonia, Spain. Josep.Llovet@mssm.edu
authors.forename: Josep M
authors.initials: JM
authors.lastname: Llovet
authors.forename: Myron
authors.initials: M
authors.lastname: Schwartz
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mazzaferro
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation; D019520:Living Donors; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D016019:Survival Analysis