Outcomes of liver resection for hepatocellular carcinoma in liver transplantation era

Abstract Aims Surgical treatment for early-stage hepatocellular carcinoma (HCC) is toward transplantation. However, liver resection remains the major surgical treatment for HCC in Asia. This study is to examine the results of liver resection when liver transplantation became an option of treatment f...

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Bibliographic Details
Published in:European journal of surgical oncology 2015-09, Vol.41 (9), p.1144-1152
Main Authors: Lee, W.-C, Lee, C.-F, Cheng, C.-H, Wu, T.-J, Chou, H.-S, Wu, T.-H, Soong, R.-S, Chan, K.-M, Yu, M.-C, Chen, M.-F
Format: Article
Language:English
Subjects:
Aged
Carcinoma, Hepatocellular - complications
Carcinoma, Hepatocellular - surgery
Cohort Studies
Disease-Free Survival
Female
Hematology, Oncology and Palliative Medicine
Hepatectomy
Hepatocellular carcinoma
Hospital Mortality
Humans
Hypertension, Portal - complications
Hypertension, Portal - surgery
Liver Neoplasms - complications
Liver Neoplasms - surgery
Liver resection
Liver Transplantation
Male
Middle Aged
Neoplasm Recurrence, Local
Outcomes
Platelet
Portal hypertension
Proportional Hazards Models
Retrospective Studies
Surgery
Taiwan
Treatment Outcome
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Summary:Abstract Aims Surgical treatment for early-stage hepatocellular carcinoma (HCC) is toward transplantation. However, liver resection remains the major surgical treatment for HCC in Asia. This study is to examine the results of liver resection when liver transplantation became an option of treatment for early-stage HCC. Methods In this retrospective cohort study, 1639 patients with resectable HCC were reviewed and divided into two groups. In the 1st period (2002–2005), all 679 patients received liver resection. In the 2nd period (2006–2010), 916 patients had liver resection and 44 patients jointed liver transplantation program. The results of treatment in these two periods were analyzed. Results The characteristics of tumors were the most important factors of tumor recurrence after liver resection. Liver function reserve, characteristics of tumors, and surgeons' endeavor were all independent factors for overall survival after liver resection. When the patients with oligo-nodular tumors or portal hypertension with low platelet count had liver transplantation rather than liver resection in the 2nd period, the survival rates in the 2nd period were improved. When the patients in the 1st period with low platelet count (≤105 × 103 /uL) were subtracted, the 5-year survival rate of the patients with one-segmentectomy for small-sized HCC in the 1st period was similar to those in the 2nd period and transplant patients. Conclusions The outcomes of liver resection were improved while liver transplantation was performed for the patients with suspicious portal hypertension. Platelet count, 105 × 103 /uL, could be a watershed for early stage HCC patients to undergo liver resection or liver transplantation.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2015.05.024