Chirurgische Therapie des hepatozellulären Karzinoms: Wann Resektion, wann Transplantation?

Abstract

Surgical Therapy of Hepatocellular Carcinoma: When Resection, When Transplantation? Hepatocellular carcinoma (HCC) accounts for 80% of all primary liver cancers. If no underlying cirrhosis is present, surgical resection is the treatment of choice. Liver resection should be performed according to liver segments (Couinaud). In case of recurrent disease confined to the liver re-resection should be undertaken. In cirrhotic patients with HCC, both transplantation and resection remain the mainstay of therapeutic options. In Child- Pugh stage A with solitary tumours limited resections are feasible under consideration of the reduced functional reserve capacity of the cirrhotic liver. Extensive portal hypertension and increased bilirubin levels should not be present. The high recurrence rate has to be considered. There is no indication for resection in patients with Child-Pugh B or C stage. Regarding early tumour stages better results are obtained following transplantation compared to resection. Therefore, in young patients with Child-Pugh A cirrhosis and HCC liver transplantation should be performed. Patient selection for transplantation should be done according to the criteria described by Mazzaferro (one lesion ≤ 5 cm or ≤ 3 lesions, each ≤ 3 cm in diameter; 75% 4-year survival). In advanced tumour stages beyond the Mazzaferro criteria there is no indication for transplantation. Living-donor liver transplantation offers the opportunity to reduce the waiting time and the risk of tumour progression.