title: Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: University of Bologna experience.
abstract: Liver resection (LR) for patients with small hepatocellular carcinoma (HCC) with preserved liver function, employing liver transplantation (LT) as a salvage procedure (SLT) in the event of HCC recurrence, is a debated strategy. From 1996 to 2005, we treated 227 cirrhotic patients with HCC transplantable: 80 LRs and 147 LTs of 293 listed for transplantation. Among 80 patients eligible for transplantation who underwent LR, 39 (49%) developed HCC recurrence and 12/39 (31%) of these patients presented HCC recurrence outside Milan criteria. Only 10 of the 39 patients underwent LT, a transplantation rate of 26% of patients with HCC recurrence. According to intention-to-treat analysis of transplantable HCC patients who underwent LR (n = 80), compared to all those listed for transplantation (n = 293), 5-year overall survival was 66% in the LR group versus 58% in patients listed for LT, respectively (p = NS); 5-year disease-free survival was 41% in the LR group versus 54% in patients listed for LT (p = NS). Comparable 5-year overall (62% vs. 73%, p = NS) and disease-free (48% vs. 71%, p = NS) survival rates were obtained for SLT and primary LT for HCC, respectively. LR is a valid treatment for small HCC and in the event of recurrence, SLT is a safe and effective procedure.
authors.affiliation: Liver and Multiorgan Transplantation unit, S. Orsola-Malpighi Hospital, University of Bologna Italy, Bologna, Italy. m_delgaudio@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.forename: M
authors.initials: M
authors.lastname: Ravaioli
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.forename: A
authors.initials: A
authors.lastname: Lauro
authors.forename: M
authors.initials: M
authors.lastname: Vivarelli
authors.forename: M
authors.initials: M
authors.lastname: Zanello
authors.forename: A
authors.initials: A
authors.lastname: Cucchetti
authors.forename: G
authors.initials: G
authors.lastname: Vetrone
authors.forename: F
authors.initials: F
authors.lastname: Tuci
authors.forename: G
authors.initials: G
authors.lastname: Ramacciato
authors.forename: G L
authors.initials: GL
authors.lastname: Grazi
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007558:Italy; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016879:Salvage Therapy