Journal article
Surgical treatment of hepatocellular carcinoma in North America: can hepatic resection still be justified?
Journal of the American College of Surgeons, Vol.220(4), pp.628-637
04/2015
DOI: 10.1016/j.jamcollsurg.2014.12.030
PMID: 25728142
Abstract
The incidence of hepatocellular cancer (HCC) is increasing dramatically worldwide. Optimal management remains undefined, especially for well-compensated cirrhosis and HCC.
This retrospective analysis included 5 US liver cancer centers. Patients with surgically treated HCC between 1990 and 2011 were analyzed; demographics, tumor characteristics, and survival rates were included.
There were 1,765 patients who underwent resection (n = 884, 50.1%) or transplantation (n = 881, 49.9%). Overall, 248 (28.1%) resected patients were transplant eligible (1 tumor <5 cm or 2 to 3 tumors all <3 cm, no major vascular invasion); these were compared with 496 transplant patients, matched based on year of transplantation and tumor status. Overall survivals at 5 and 10 years were significantly improved for transplantation patients (74.3% vs 52.8% and 53.7% vs 21.7% respectively, p < 0.001), with greater differences in disease-free survival (71.8% vs 30.1% at 5 years and 53.4% vs 11.7% at 10 years, p < 0.001). Ninety-seven of the 884 (11%) resected patients were within Milan criteria and had cirrhosis; these were compared with the 496 transplantation patients, with similar results to the overall group. On multivariate analysis, type of surgery was an independent variable affecting all survival outcomes.
The increasing incidence of HCC stresses limited resources. Although transplantation results in better long-term survival, limited donor availability precludes widespread application. Hepatic resection will likely remain a standard therapy in selected patients with HCC. In this large series, only about 10% of patients with cirrhosis were transplant-eligible based on tumor status. Although liver transplantation results are significantly improved compared with resection, transplantation is available only for a minority of patients with HCC.
Details
- Title: Subtitle
- Surgical treatment of hepatocellular carcinoma in North America: can hepatic resection still be justified?
- Creators
- William C Chapman - Washington University in St. LouisGoran Klintmalm - Baylor UniversityAlan Hemming - UC San Diego Health SystemNeeta Vachharajani - Washington University in St. LouisMaria B. Majella Doyle - Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MORon DeMatteo - Memorial Sloan Kettering Cancer CenterVictor Zaydfudim - University of Virginia Health SystemHaniee Chung - Washington University in St. LouisKeith Cavaness - Baylor UniversityRobert Goldstein - Baylor UniversityIvan Zendajas - University of Florida HealthLaleh G Melstrom - Rutgers, The State University of New JerseyDavid Nagorney - Department of Surgery; Mayo Clinic; Rochester MNWilliam Jarnagin - Memorial Sloan Kettering Cancer Center
- Resource Type
- Journal article
- Publication Details
- Journal of the American College of Surgeons, Vol.220(4), pp.628-637
- DOI
- 10.1016/j.jamcollsurg.2014.12.030
- PMID
- 25728142
- ISSN
- 1072-7515
- eISSN
- 1879-1190
- Language
- English
- Date published
- 04/2015
- Academic Unit
- Surgery
- Record Identifier
- 9984321865002771
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