title: Comparison of outcomes of transplantation and resection in patients with early hepatocellular carcinoma: a meta-analysis.
abstract: OBJECTIVE
  Surgical decision making for patients with early hepatocellular carcinoma (HCC) and well-compensated cirrhosis remains controversial. The aim of the current study was to conduct a meta-analysis of published reports to compare survival outcomes after transplantation and resection, respectively, in patients with early HCC [i.e. HCC falling within the Milan Criteria (a solitary lesion measuring ≤5 cm or fewer than three lesions with a largest diameter of ≤3 cm, and absence of macroscopic vascular invasion or extrahepatic disease)] and well-compensated cirrhosis.
  
  
  METHODS
  A total of 990 abstracts were identified through a PubMed-based search. Ten articles comparing transplantation and resection in patients with early HCC were included in the meta-analysis. Meta-analysis was performed using stata 9.2 statistical software.
  
  
  RESULTS
  Outcomes were analysed for a total of 1763 patients with early HCC. The 5-year overall survival (OS) for all patients was 58% (transplantation: 63%; resection: 53%). Meta-analysis of all 10 studies revealed a survival advantage for transplantation [odds ratio (OR) 0.581, 95% confidence interval (CI) 0.359-0.939; P = 0.027]. Analysis of only those reports that utilized an 'intention-to-treat' strategy failed to demonstrate a survival advantage for either treatment approach (OR 0.600, 95% CI 0.291-1.237; P = 0.166).
  
  
  CONCLUSIONS
  The current study demonstrates a favourable outcome in patients with early HCC treated by either transplantation or resection. Although transplantation was noted to have a survival advantage in some settings, resection continues to be a viable treatment approach.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Eppley Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Mashaal
authors.initials: M
authors.lastname: Dhir
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Lyden
authors.forename: Lynette M
authors.initials: LM
authors.lastname: Smith
authors.forename: Chandrakanth
authors.initials: C
authors.lastname: Are
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D009010:Monte Carlo Method; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden