Liver Transplantation for Hepatocellular Carcinoma: Single Nodule with Child-Pugh Class A Sized Less than 3 cm

Abstract

Backgrounds/Aims: Hepatic resection (HR) has been the standard therapy for patients with small hepatocellular carcinoma (HCC) with preserved liver function in Child A cirrhosis. However, the underlying cirrhosis is responsible for high recurrence and long-term complications of portal hypertension and liver failure. Currently, liver transplantation (LT) has proven to be a good alternative to HR. We studied to determine whether LT could be an alternative initial therapy or not in HCC patients with less than 3 cm-sized, single nodule with Child A cirrhosis. Methods: From January 1995 to December 2005, there were 100 HR and 17 LT (living donor LT 15, deceased donor LT 2) patients. Clinicopathologic characteristics were reviewed and survival rates between LT and HR groups were compared. The applicability of salvage LT at the time of recurrence was also evaluated. Results: There was no difference in age, sex, etiology and in-hospital mortality between the two groups. LTs were not performed for the patients with preserved liver function, that is, BCLC stage A1. Most initial recurrences after HR occurred in liver (37/39), but only one recurrence after LT occurred in lung. Overall survival differences between LT and HR were not significant. However, disease-free survival after LT and HR were significantly different (p = 0.047). Potential candidates for salvage LT were 37 patients including hepatic failure (n = 10), and its applicability on recurrence was 69.2% (27/39). Conclusion: HR is still a good option for the selected patients because of lower cost and no requirement of donors. However, primary LT can be a treatment of choice for single, small HCC of Child A cirrhosis in the presence of portal hypertension because of excellent disease-free survival.

Good longterm survival after primary living donor liver transplantation for solitary hepatocellular carcinomas up to 8cm in diameter

“…A long waiting time and a high dropout rate provide justification for LDLT, with which the uncertainty about waiting time and the risk for dropping out can virtually be eliminated, and the overall applicability of LT has risen from 12% to >50%. In regions with a low rate of deceased donor organ donation and good LDLT results, there is a trend towards offering LDLTs to patients with HCC but preserved liver function . Hepatocellular carcinoma accounts for a third of the indications for LT in Asia, and 96% of LTs for HCC are LDLTs …”

Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion

“…Justification of LDLT is therefore poor [32]. In a study from Asan Medical Center [33], LR and LT did not cause any difference in survival for patients with Child–Pugh A cirrhosis and a single HCC smaller than 3 cm. In the series, the LR group ( n  = 100) had a 5-year survival rate of 66.5%, whereas the LT group ( n  = 17) had the rate at 94.1%, and only 1 of the 17 patients died.…”

Liver transplantation and conventional surgery for advanced hepatocellular carcinoma

“…HR is the treatment of choice for HCC, but its long‐term result is impaired by tumor recurrence and progressive worsening of liver function. Even in patients with small HCC and preserved liver function, long‐term outcome after HR is definitely inferior to LT [37]. It is generally accepted that there is 10% loss of patients per year due to progressive liver failure or tumor recurrence after HR of a small tumor in Child class A patients.…”