title: Superiority of transplantation versus resection for the treatment of small hepatocellular carcinoma.
abstract: The best therapy for hepatocellular carcinoma (HCC) is still debated. Hepatic resection (HR) is the treatment of choice for single HCC in Child A patients, whereas liver transplantation (OLT) is usually reserved for Child B and C patients with multiple nodules. The aim of this study was to compare HR and OLT for HCC within the Milan criteria on an intention-to-treat basis. Forty-eight patients were treated by OLT and 38 by HR. Three- and 5-year patient survival rates were significantly higher (P = .0057) in the OLT group (79% and 74%) than after HR (61% and 26%). The 3- and 5-year disease-free survival rate was better (P = .0005) for OLT (74% and 74%) versus HR (41% and 11%). The probability of HCC recurrences after resection was greater (P = .0002) than after transplantation, achieving 31% and 76% for HR and 2% and 2% for OLT at 3 and 5 years after surgery. The median waiting list time was 118 days; two patients dropped out for HCC progression. We concluded that OLT is superior to HR for small HCC in cirrhotic patients assuming that OLT can be performed within 6 to 10 months after listing to reduce dropouts due to tumor progression.
authors: Department of Surgery and Transplantation, University Hospital of Udine, Udine, Italy. umberto.baccarani@uniud.it
authors: U
authors: U
authors: Baccarani
authors: E
authors: E
authors: Benzoni
authors: G L
authors: GL
authors: Adani
authors: C
authors: C
authors: Avellini
authors: D
authors: D
authors: Lorenzin
authors: M
authors: M
authors: Sainz-Barriga
authors: V
authors: V
authors: Bresadola
authors: A
authors: A
authors: Uzzau
authors: A
authors: A
authors: Risaliti
authors: C A
authors: CA
authors: Beltrami
authors: F
authors: F
authors: Bresadola
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000601:surgery; D006526:Hepatitis C / Q000150:complications / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome