Resection and Liver Transplantation for Hepatocellular Carcinoma

Josep M. Llovet; Myron Schwartz; Vincenzo Mazzaferro

doi:10.1055/s-2005-871198

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2005; 25(2): 181-200
DOI: 10.1055/s-2005-871198

Resection and Liver Transplantation for Hepatocellular Carcinoma

Josep M. Llovet¹ ^, ² , Myron Schwartz² , Vincenzo Mazzaferro³

¹Senior Researcher, BCLC Group, Liver Unit, Digestive Disease Institute, IDIBAPS, Hospital Clínic, University of Barcelona, Catalonia, Spain
²Division of Liver Diseases and Recanati Miller Transplantation Institute, Mount Sinai School of Medicine, New York, New York
³G.I. Surgery and Liver Transplantation Unit, National Cancer Institute, Milan, Italy

Abstract

ABSTRACT

Surveillance programs in cirrhotic patients enable the detection of hepatocellular carcinoma (HCC) at early stages, when the tumor is amenable to curative treatments (60% of cases in Japan; 25 to 40% in Europe and the United States). Resection is the mainstay of treatment in noncirrhotic patients and in cirrhotics with well-preserved liver function. In modern series, a perioperative mortality ≤ 3% and 5-year survival rates above 50% are expected. Tumor recurrence complicates half of the cases at 3 years, but there is no unquestionable preventive treatment. Liver transplantation provides excellent outcomes applying the Milan criteria (single nodule ≤ 5 cm or two or three nodules ≤ 3 cm), with 5-year survival rates of 70% and low recurrence rates. Although expansion of selection criteria is appealing, it should be assessed in the setting of prospective well-designed studies. Intention-to-treat analysis has shown that wide extended indications lead to 25% 5-year survival rates. Living donor liver transplantation is having a minor impact in HCC management. Molecular markers are needed to better select the candidates for surgery.

KEYWORDS

Hepatocellular carcinoma - resection - liver transplantation - living donor liver transplantation - adjuvant treatments

Full Text

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Josep M LlovetM.D.

Division of Liver Diseases, RM Transplantation Institute, Mount Sinai School of Medicine

1425 Madison Ave, 11F-70, Box:1104

New York, NY10029

Email: Josep.Llovet@mssm.edu