title: IS RESECTION OF HEPATOCELLULAR CARCINOMA IN THE ERA OF LIVER TRANSPLANTATION WORTHWILE? A single center experience.
abstract: BACKGROUND
  - Liver resection for hepatocellular carcinoma is a potentially curative therapeutic procedure that can be performed readily after its indication, without the need of a long waiting time and lower costs when compared to liver transplantation, being a good alternative in patients with preserved/good liver function.
  
  
  OBJECTIVE
  - Evaluate long-term results of liver resection from a high volume single center for selected patients with hepatocellular carcinoma in a context of a long waiting list for liver transplant.
  
  
  METHODS
  - One hundred and one patients with hepatocellular carcinoma, with a mean age of 63.1 years, and preserved liver function were submitted to liver resection. Clinical and pathological data were evaluated as prognostic factors. Mean follow-up was 39.3 months.
  
  
  RESULTS
  - All patients had a single nodule and 57 (58.2%) patients were within the Milan criteria. The size of the nodule ranged from 1 to 24 cm in diameter. In 74 patients, liver resection was performed with the open approach and in 27 (26.7%) was done laparoscopically. Postoperative morbidity was 55.3% being 75.5% of the complications classified as Dindo-Clavien I and II and operative mortality was 6.9%. Five-year overall and disease free survival rates were 49.9% and 40.7%, respectively.After a log-rank univariate analysis, the levels of preoperative alpha-fetoprotein (P=0.043), CA19-9 (P=0.028), capsule invasion (P=0.03), positive margin (R1-R2) (P=0.004) and Dindo-Claviens' morbidity classification IV (P=0.001) were the only parameters that had a significant negative impact on overall survival. On the odds-ratio evaluation, the only significant factors for survival were high levels of alpha-fetoprotein (P=0.037), and absence of free margins (P=0.008).
  
  
  CONCLUSIONS
  - Resection, for selected cases, is a potentially curative treatment with acceptable morbidity and mortality and, in a context of a long waiting list for transplant, plays an important role for the treatment of hepatocellular carcinoma.
authors.affiliation: Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.affiliation: Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
authors.forename: Felipe de Lucena Moreira
authors.initials: Fde L
authors.lastname: Lopes
authors.affiliation: Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
authors.forename: Jaime Arthur Pirola
authors.initials: JA
authors.lastname: Kruger
authors.affiliation: Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
authors.forename: Gilton Marques
authors.initials: GM
authors.lastname: Fonseca
authors.affiliation: Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
authors.forename: Vagner Birk
authors.initials: VB
authors.lastname: Jeismann
authors.affiliation: Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
authors.forename: Fabricio Ferreira
authors.initials: FF
authors.lastname: Coelho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy / Q000401:mortality; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012008:Recurrence; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014850:Waiting Lists; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins