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 (LT) is usually reserved for Child B and C patients with single or multiple nodules. The aim of this study was to compare HR and LT for HCC within the Milan criteria on an intention-to-treat basis. Forty-eight patients were treated by LT and 38 by HR. The median time on the waiting list for transplantation was 118 days. The estimated overall survival was significantly higher (P = 0.005) in the LT group than in the HR one. The estimated freedom from recurrence was also significantly higher (P < 0.0001) for LT patients than for HR ones. Indeed, the probability of HCC recurrence after resection was higher than after transplantation achieving 31% and 76% for HR and 2% and 2% for LT at 3 and 5 years after surgery. Multivariate analysis confirmed that transplantation was superior to resection in terms of patient's survival and risk of HCC recurrence. We conclude that LT is superior to HR for small HCC in cirrhotic patients assuming that LT should be performed within 6-10 months after listing to reduce the dropouts for reasons of tumor progression.
authors.affiliation: Department of Surgery and Transplantation, University Hospital of Udine, Udine, Italy. umberto.baccarani@uniud.it
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.forename: Miriam
authors.initials: M
authors.lastname: Isola
authors.forename: Gian L
authors.initials: GL
authors.lastname: Adani
authors.forename: Enrico
authors.initials: E
authors.lastname: Benzoni
authors.forename: Claudio
authors.initials: C
authors.lastname: Avellini
authors.forename: Dario
authors.initials: D
authors.lastname: Lorenzin
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bresadola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Uzzau
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
authors.forename: Antonio P
authors.initials: AP
authors.lastname: Beltrami
authors.forename: Franca
authors.initials: F
authors.lastname: Soldano
authors.forename: Dino
authors.initials: D
authors.lastname: De Anna
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bresadola
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome