title: Current role of surgery in treatment of early stage hepatocellular carcinoma: resection versus liver transplantation.
abstract: Hepatocellular carcinoma (HCC) is the most common malignancy of the liver and is most commonly associated with hepatitis B infection in Korea. Although liver resection is regarded as a potentially curative treatment option, it is only feasible in less than 20% of patients. The reason for this is that HCC arises in cirrhotic livers and is often multicentric. Liver transplantation (LT) which could be used in the treatment both of the tumor and background liver seems to be a rational approach for early stage patients with decompensated liver cirrhosis. Current good selection criteria of LT for HCC are the Milan criteria: 1 HCC nodule < or =5 cm in diameter or 3 nodules < or =3 cm. By restricting LT to patients within the Milan criteria, the 4-year disease-free survival rate was more than 80%, which is comparable to that of a transplant candidate without HCC. However, there are serious limitations for the wider application of LT for HCC: (1) organ shortage, (2) risk to a live donor, (3) high cost, and (4) lifelong immunosuppression. For this reason, for a patient with early stage HCC and with Child A cirrhosis in whom partial hepatectomy is possible, the choice of primary treatment with curative intent is still under debate.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Taehoon
authors.initials: T
authors.lastname: Kim
authors.forename: Joohyun
authors.initials: J
authors.lastname: Kim
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Shin
authors.forename: Kuhn-Uk
authors.initials: KU
authors.lastname: Lee
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000191:economics; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D009367:Neoplasm Staging; D011788:Quality of Life; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents