Results of Resection and Transplantation for Hepatocellular Carcinoma in Cirrhosis and Noncirrhosis

Rayya, Fadi; Harms, Jens; Bartels, Michael; Uhlmann, Dirk; Hauss, Johann; Fangmann, J.

doi:10.1016/j.transproceed.2008.03.045

Cited by 26 publications

(14 citation statements)

References 10 publications

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“…Interestingly, several reports have suggested that outcome after partial liver resection for NC-HCC is not influenced by tumor size [10,16,17]. Most recent series have indicated that partial liver resection for NC-HCC may result in 5-year survival rates varying between 40% and 70% and 5-year tumor-free survival rates varying between 30% and 50% [6,8,10,[16][17][18][19][20][21][22][23][24]. The prognosis for unresectable NC-HCC, however, is rather poor with an expected median survival time of about 30-40 weeks and a 5-year survival rate <3% [25,26].…”

Section: Partial Liver Resectionmentioning

confidence: 99%

Liver transplantation for unresectable hepatocellular carcinoma in patients without liver cirrhosis

Mergental¹,

Porte²

2010

Transplant International

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Summary Hepatocellular carcinoma (HCC) arising in noncirrhotic and nonfibrotic liver (NC‐HCC) is a rare type of malignancy frequently found in healthy young individuals. Partial liver resection is the treatment of choice with expected 5‐year survival rates between 40% and 70%. As a result of absence of any symptom, a considerable number of patients are diagnosed when the malignancy has progressed to an advanced stage and the tumor has turned already unresectable. Some other patients suffer from intrahepatic recurrence after previous liver resection that cannot be re‐resected or locally ablated. In these situations, liver transplantation (LT) may be the only potentially curative treatment. The indication for LT in NC‐HCC patients, however, is not well established. The preliminary results of recent analysis of the European Liver Transplant Registry (ELTR) together with a literature review identified over 150 patients transplanted for NC‐HCC during the last 15 years. In contrast to the historical data, these studies showed 5‐year survival rates at 50–70% in well‐selected patients. Important determinants of poor outcome are macrovascular invasion, lymph node involvement, and time interval of <12 months when LT is used as rescue therapy for intrahepatic recurrence after a previous partial liver resection. Interestingly, outcomes after both liver resection and LT for NC‐HCC are much less influenced by tumor size than is the case with cirrhotic HCC. A large tumor size per se should, therefore, not to be seen as a strict contraindication for performing LT in patients with NC‐HCC.

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Section: Partial Liver Resectionmentioning

confidence: 99%

Liver transplantation for unresectable hepatocellular carcinoma in patients without liver cirrhosis

Mergental¹,

Porte²

2010

Transplant International

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“…1,5,6 Among the diseases requiring surgical procedures, cirrhotic patients are especially prone to the following: abdominal wall hernias of all kinds due to ascites, gastrointestinal bleeding disorders due to portal hypertension, and also perforations of the intestine. While surgical resection and transplantation for hepatocellular carcinoma have been looked at intensively in cirrhotic patients, [7][8][9][10][11] general and abdominal surgery procedures (e.g., cholecystectomy, abdominal wall hernias, procedures of the GI tract) have not been scrutinized in the same manner. For reference, studies including larger numbers of patients (>40) are either few or limited 1,6,[12][13][14] or date from the past decade.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Mortality After Non-hepatic General Surgery in Patients with Liver Cirrhosis: an Analysis of 138 Operations in the 2000s Using Child and MELD Scores

Neeff

Mariaskin

Spangenberg

et al. 2011

Journal of Gastrointestinal Surgery

147

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Our results demonstrate that perioperative mortality remains high in patients with liver cirrhosisundergoing general surgery, especially in emergent situations. Patients with poor liver function and/or need for blood transfusions even had a very high mortality. In our experience, the Child score (together with other variables) independently correlates with perioperative mortality in emergent operations whereas the MELD score was inferior in predicting the outcome.

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“…Liver Resection [7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 1) The articles reviewed for information on partial liver resection for NC-HCC include 2263 patients; the numbers of patients in these series range from 20 to 254. [7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The results of the French multicenter ...…”

Section: Resultsmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The results of the French multicenter study, 1 which includes the world's largest series of resections for HCC arising in normal livers (ie, nonfibrotic and noncirrhotic), are discussed separately. The larger studies come from regions with high rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections.…”

Section: Resultsmentioning

confidence: 99%

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

et al. 2011

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Hepatocellular carcinoma (HCC) is a relatively common cancer and occurs mainly in patients with liver cirrhosis (85%-95%). A significant number of cases are, however, diagnosed in normal and noncirrhotic/nonfibrotic livers. In contrast to HCC in a cirrhotic liver, noncirrhotic hepatocellular carcinoma (NC-HCC) predominantly occurs in young and healthy female patients in their 30s, and the diagnosis is frequently made at an advanced stage in the absence of a clear etiological factor. [1][2][3] The same holds true for the uncommon fibrolamellar hepatocellular carcinoma (FL-HCC) variant. [1][2][3] Several studies have shown that the 3-year overall survival (OS) rates with different pharmaceutical, radiological, and surgical therapies for HCC (if they are adequately performed) are approximately 60%. 4 After 3 years, the results of these treatments start to diverge substantially with respect to OS and, most importantly, with respect to disease-free survival (DFS). Long-term follow-up (5-10 years) has clearly shown that surgical resection is the only curative treatment for any kind of HCC. [2][3][4][5] With respect to very long-term DFS (>5 years), liver transplantation (LT) offers the best results. 2,4-6 In order to be successful, surgery has to be adapted to the tumor, the underlying condition of the patient, and the patient's liver. Liver resection and LT should have complementary roles rather than competing ones, and they should be associated with each other instead of being opposed. 5 Partial resection for HCC can be considered only for patients with well-compensated cirrhosis or fibrosis or with normal liver tissue. For patients with decompensated liver disease, cirrhosis, or a technically unresectable tumor, LT offers the best chance for a cure. This option indeed addresses the tumor as well as the underlying liver disease.Despite the extensive experience with LT for the treatment of HCC in patients with cirrhosis, the experience with LT for the treatment of NC-HCC is anecdotal and is limited to situations in which resection is not possible.The aims of this study were as follows: (1) to analyze the results from recent series of partial liver resections for NC-HCC, (2) to compare these results with the results of LT for the same condition; and (3) to propose an adaptation of the therapeutic algorithm for NC-HCC on the basis of these analyses.

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Results of Resection and Transplantation for Hepatocellular Carcinoma in Cirrhosis and Noncirrhosis

Cited by 26 publications

References 10 publications

Liver transplantation for unresectable hepatocellular carcinoma in patients without liver cirrhosis

Liver transplantation for unresectable hepatocellular carcinoma in patients without liver cirrhosis

Perioperative Mortality After Non-hepatic General Surgery in Patients with Liver Cirrhosis: an Analysis of 138 Operations in the 2000s Using Child and MELD Scores

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

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