Oncological Outcomes of Hepatic Resection vs Transplantation for Localized Hepatocellular Carcinoma

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Akcam A. T., Saritas A. G., Ulku A., Rencuzogullari A.

TRANSPLANTATION PROCEEDINGS, vol.51, pp.1147-1152, 2019 (SCI-Expanded) identifier identifier identifier


Background. Scarce data are available comparing outcomes of hepatic resection vs
orthotopic liver transplantation (OLT) for localized hepatocellular carcinoma (HCC) patients
both meeting and exceeding the Milan criteria. This study compared the clinical and
oncological outcomes of patients undergoing hepatic resection vs transplantation localized
Method. Between January 2005 and February 2017, clinical and oncological outcomes of
patients who underwent liver resection (n ¼ 38) vs OLT (n ¼ 28) for localized HCC were
compared using a prospectively maintained database.
Results. A total of 66 patients (with a median age of 62) who met the study criteria were
analyzed. Comparable postoperative complications (13.2% vs 28.6%, P ¼ .45) and perioperative
mortality rates (7.9% vs 10.7%, P ¼ .2) were noted for the resection vs OLT
groups. While Child-Pugh Class A patients were more prevalent in the resection group
(78.9% vs 7.1%, P ¼ .0001), the rate of patients who met the Milan criteria was higher
in the OLT group (89.3% vs 34.25, P ¼ .0001). Recurrence rates were 36.8% in the
resection group and 3.6% in the OLT group at the end of the median follow-up period
(32 vs 39 months, respectively). The HCC-related mortality rate was significantly higher
in the resection group (39.5% vs 10.7%, P ¼ .034).
However, a subgroup analysis of patients who met the Milan criteria revealed similar rates
of recurrence and HCC-related mortality (15.4% vs 8%, P ¼ .63). Based on logistic
regression analysis, number of tumors (P ¼ .034, odds ratio: 2.1) and “resection”-type
surgery (P ¼ .008, odds ratio: 20.2) were independently associated with recurrence.
Conclusion. Compared to liver transplantation, hepatic resection for localized hepatocellular
carcinoma is associated with a higher rate of recurrence and disease-related