Background and aim. The choice of the best surgical strategy for early hepatocellular carcinoma (HCC) on well-compensated cirrhosis is still controversial. Liver transplantation (LT) permits the simultaneous treatment of HCC and cirrhosis, but donor organ shortage doesn’t allow a widespread utilization of this therapeutic option. In several series, 5-years patient survival after liver resection (LR) and after LT is similar, but all studies are based on retrospective comparisons of cohorts of heterogeneous patients in pre-surgical characteristics. We designed a retrospective, 1:1 ratio case-controlled study between patients affected by HCC on well compensated cirrhosis undergoing LT vs LR. Aim of the study is to evaluate morbidity, mortality, patient survival and disease-free survival (DSF) of the two considered groups. Materials and Methods. Since 10-2000 to 01-2008 in our transplant centre, 129 LT and 105 LR were performed for histological confirmed HCC. Thirty-five liver transplant recipients (Transplant Group, TG), without a previous liver resection, were paired with 35 patients that underwent a liver resection (Resection Group, RG), not afterwards been transplanted, matched by: MELD ≤15, HCC fulfilling Milan criteria, gender, age, surgical year and liver disease etiology (HBV/HCV/alcoholic). DFS events were defined as HCC recurrence or end-stage liver failure due to primary indication recurrence. Results. Overall patients average follow-up was 52 months. The overall patient survival at 1, 3, 5 yrs was, respectively, 82.4%, 71.7% and 71.7% in TG vs 94.3%, 65.6% and 22.0% in RG (p=0,014). The DFS at the same time points was 96.7%, 83.9% and 83.9% in TG vs 65.7%, 32.4% and 9.2% in RG (p=0,000). Morbidity in terms of: infections, renal impairment, and also the complications occurring exclusively following LT, resulted statistically higher in TG. HCC recurrence occurred in 5,7% of patients of TG vs 51,4% of patients of RG. In RG the 61% of patients with HCC recurrence died because of the recurrence. Discussion. In patients with HCC within Milan criteria on well compensated cirrhosis, LT and LR during early and middle term follow-up allow to obtain similar results in terms of patient survival and DFS, whereas in the long term the advantage of LT is manifest.
Liver resection versus liver transplantation as treatment of early hepatocellular carcinoma: a case-control study / Montalti, R; Serra, V; Rompianesi, G; Di Benedetto, F; De Ruvo, N; Masetti, M; Cautero, N; Ballarin, R; Iemmolo, Rm; Guerrini, Gp; Gerunda, Ge. - (2009). (Intervento presentato al convegno International Liver Transplantation Society (ILTS) 15th Annual International Congress tenutosi a New York, NY. nel July 08 - 11, 2009).
Liver resection versus liver transplantation as treatment of early hepatocellular carcinoma: a case-control study
Montalti R
;Rompianesi G;
2009
Abstract
Background and aim. The choice of the best surgical strategy for early hepatocellular carcinoma (HCC) on well-compensated cirrhosis is still controversial. Liver transplantation (LT) permits the simultaneous treatment of HCC and cirrhosis, but donor organ shortage doesn’t allow a widespread utilization of this therapeutic option. In several series, 5-years patient survival after liver resection (LR) and after LT is similar, but all studies are based on retrospective comparisons of cohorts of heterogeneous patients in pre-surgical characteristics. We designed a retrospective, 1:1 ratio case-controlled study between patients affected by HCC on well compensated cirrhosis undergoing LT vs LR. Aim of the study is to evaluate morbidity, mortality, patient survival and disease-free survival (DSF) of the two considered groups. Materials and Methods. Since 10-2000 to 01-2008 in our transplant centre, 129 LT and 105 LR were performed for histological confirmed HCC. Thirty-five liver transplant recipients (Transplant Group, TG), without a previous liver resection, were paired with 35 patients that underwent a liver resection (Resection Group, RG), not afterwards been transplanted, matched by: MELD ≤15, HCC fulfilling Milan criteria, gender, age, surgical year and liver disease etiology (HBV/HCV/alcoholic). DFS events were defined as HCC recurrence or end-stage liver failure due to primary indication recurrence. Results. Overall patients average follow-up was 52 months. The overall patient survival at 1, 3, 5 yrs was, respectively, 82.4%, 71.7% and 71.7% in TG vs 94.3%, 65.6% and 22.0% in RG (p=0,014). The DFS at the same time points was 96.7%, 83.9% and 83.9% in TG vs 65.7%, 32.4% and 9.2% in RG (p=0,000). Morbidity in terms of: infections, renal impairment, and also the complications occurring exclusively following LT, resulted statistically higher in TG. HCC recurrence occurred in 5,7% of patients of TG vs 51,4% of patients of RG. In RG the 61% of patients with HCC recurrence died because of the recurrence. Discussion. In patients with HCC within Milan criteria on well compensated cirrhosis, LT and LR during early and middle term follow-up allow to obtain similar results in terms of patient survival and DFS, whereas in the long term the advantage of LT is manifest.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
