[Local therapy for hepatocellular carcinoma as a bridge to liver transplantation].
OBJECTIVE
To analyze the results of pre-operative local therapy for hepatocellular carcinoma in patients who were subjected to liver transplantation.


METHODS
Cadaveric and living-related liver transplants done in cirrotic patients with hepatocellular carcinoma within the Milan criteria were included. The nodules were analyzed according to its number and diameter before and after the institution of the local therapy and on the explant evaluation.


RESULTS
22 patients with 31 nodules that measured 28.8+/-12 mm in diameter were included. They were subjected to 21 sessions of percutaneous ethanol injection and 29 sessions of transarterial chemoembolization. After the local therapy, 29 nodules that measured 24.6+/-12 mm in diameter were detected. All of them were within the Milan criteria and there was no difference compared to the diameter before the treatment. The patients were subjected to 17 cadaveric and 5 living-related liver transplantations. In six cases the tumors exceeded the Milan criteria on the explant evaluation: 4 due to its number and 2 due to its diameter. Sixteen cases were within the criteria and there were 14 neoplastic nodules with 30+/-14 mm in diameter. In these cases no difference was observed compared to the diameter before and after the local therapy.


CONCLUSIONS
Local therapy for hepatocellular carcinoma with percutaneous ethanol injection and transarterial chemoembolization partially controlled tumor evolution considering the Milan criteria in patients waiting for liver transplantation. Significant differences were observed in terms of the Milan criteria on pre-operative examination compared to the explant evaluation.
Freitas
Alexandre Coutinho Teixeira de
AC
Departamento de Cirurgia, Universidade Federal do Paraná, Curitiba, PR, BR. alexandrefreitas@ufpr.br
Dias
Josiane Mourão
JM
Parolin
Mônica Beatriz
MB
Matias
Jorge Eduardo Fouto
JE
Celho
Júlio Cezar Uili
JC
D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D047368:Tumor Burden
D000431:Ethanol