Surgical therapy offers the only chance for long-term cure of patients with hepatocellular carcinoma. The role of partial and total hepatectomy with subsequent liver replacement was analyzed in a consecutive series of 198 patients. It was the aim of this study to compare both treatment modalities on the basis of various clinicopathological prognostic factors including the TNM system of pathological classification. One hundred thirty-one resections and 61 transplantations were performed for the following histological diagnoses: hepatocellular carcinoma without coexisting liver disease (86) or associated with various hepatic abnormalities (79), fibrolamellar carcinoma (19), and mixed hepatocholangiocellular carcinoma (8). Overall actuarial survival rates at 5 years were 35.8% following resection and 15.2% after transplantation, respectively. For partial hepatectomy, factors significantly associated with improved long-term outcome were: age 30-50 years, hepatocellular carcinoma without coexisting liver disease, fibrolamellar carcinoma, solitary tumor, unilobar location, absence of vascular invasion, portal vein thrombosis or extrahepatic spread, primary tumor categories pT 2/3, stage groups II/III, and curative operation (R0). Regarding total hepatectomy, the corresponding figures were: pT2, absence of portal vein thrombosis or extrahepatic spread (negative regional lymph nodes, no distant metastases), stage group II, and curative surgery. It could be clearly shown by uni- and multivariate analyses that the pTNM classification is of clinical value regarding the assessment of prognostic significance after resection and transplantation. A group of 13 patients had secondary resection (8) or transplantation (6) for intrahepatic tumor recurrence. Whereas in all resected patients cancer recurred again, 5 of 6 transplant recipients are alive and disease-free at 12-40 months. The results of this study demonstrate that liver resection is the treatment of choice for primary liver cancer while transplantation may be indicated, especially in cases of nonresectable or recurrent lesions. Thus, the therapeutic spectrum for hepatocellular carcinoma should include both partial and total hepatectomy, being integrated into one common concept.

Resection remains the treatment of choice in proximal bile duct carcinoma. Whenever possible, decisions about resectability should be made during laparotomy. With regard to the observation of long-term survivors, liver transplantation still can be justified in selected patients with stage II carcinoma. It is unknown whether more radical procedures, such as liver transplantation combined with multivisceral resections, will lead to better outcome in advanced stages. With regard to palliation, surgical drainage of the biliary system performed as hepatojejunostomy can be recommended.

cirrhotic patients undergoing LTx are not well investigated. 1,2 The clinical relevance of malnutrition and hypermePatients with fulminant hepatic failure, patients over 40 tabolism in end-stage liver disease, as well as their efyears of age with postnecrotic cirrhosis, patients with maligfects on survival after liver transplantation (LTx), are nant disease, children with malnutrition, and hepatitis B largely unknown. This study investigates the prognostic and delta virus carriers have been suggested to have inferior value of nutritional and metabolic parameters obtained survival after LTx. [3][4][5][6][7][8] In addition, some dynamic tests like before LTx for survival after LTx. One hundred fifty pathe monoethylglycinexylide test, plasma amino acid levels tients with end-stage liver disease undergoing LTx were and clearance, the branched-chain to aromatic amino acid assessed prospectively and followed for a mean period ratio, and the arterial ketone body ratio have been shown to of 46 { 16 months after LTx. All patients were randomhave some prognostic value in patients undergoing LTx. 9 ized into a study group and a validation group, each However, the consequences of malnutrition and hypermecomprising 75 patients. Body composition analysis (24-tabolism on the liver transplantation patient have not been hour urinary creatinine excretion, anthropometry, bioadequately addressed in clinical studies. Malnutrition is a electrical impedance analysis), deviation of measured common finding in patients with advanced liver disease, and from predicted resting energy expenditure (DREE), most transplantation candidates show at least mild nutriyear of transplantation, and several variables known to tional depletion at the time of initial evaluation. 9,10 Although be of prognostic relevance in patients with liver disease individual nutritional parameters lack sensitivity in patients undergoing conservative treatment were analyzed.with end-stage liver disease, it is known that protein calorie Kaplan-Meier and log rank analysis showed that hypermalnutrition is widely prevalent in these patients. 11,12 metabolic patients (DREE ú /20%) and patients with a Clinical evaluation of nutritional status was associated body cell mass (BCM) õ 35% of body weight tended to with outcome after abdominal surgery and survival after LTx have reduced survival after LTx. A risk profile on the in studies by Garrison and Shaw. 13,14 The only reported risk basis of DREE and BCM identified patients with high score for 6-month survival after LTx by Shaw et al. considrisk (5-year survival rate, 54%) and low risk (5-year surered malnutrition as a potentially reversible component. 14 A vival rate, 88%; P õ .01). The predictive power of this drawback of the Shaw equation is that his malnutrition score risk profile was independent of the presence of ascites is based on subjective assessment rather than objective criteand clinical edema, and its validity was confirmed in the ria. Our study investigates the use of objective nutritional validation group (P õ .0...