Results of Resection and Transplantation for HCC in Cirrhosis and non-Cirrhosis

Background : Hepatocellular carcinoma (HCC) is one of the most common cancer worldwide. Both resection and transplantation are surgical treatment options depending on the size of tumours and the presence of cirrhosis. Liver cirrhosis is the main reason for the high early postoperative mortality after resection. Even in the Child A stage, extensive resections are not recommended.

Objectives: This study presents the results of the surgical treatment (LR or LT) for HCC in cirrhotic- and non cirrhotic livers.

Patients and methods: We analysed the data of 76 patients who underwent LR or LT for HCC from January 2001 to December 2006.

Results: In non cirrhotic livers the following resections were performed: 30 right and extended right hemihepatectomies (54,5%), 11 left hemihepatectomies (20%) and 14 mono- or bisegmentectomies (25,5%). In cirrhotic livers were performed in Child A stage 1 right hemihepatectomy, 1 extended right hemihepatectomy, 1 extended left hemihepatectomy and 4 mono- or bisegmentectomies and in Child B stage 3 mono- or bisegmentectomies. In 11 patients who underwent transplantation were 2 patients with tumors exceeding the Milan criteria and 5 patients of them (5/11) were treated with TACE before the transplantation.

Conclusion:

Liver resection for HCC in cirrhosis should be performed with caution (no long-term survival in our data). Our study confirms that transplantation shows good long- term survival in early HCC stages. However, this may also be true for stages above the Milan criteria. For HCC in non-cirrhotic livers resection remains the treatment of choice, justifying an extensive surgical approach. This achieves favourable long term survival as demonstrated in the study presented