Hepatocellular carcinoma: Resection vs. transplantation
COLOGNE. Liver transplantation is the gold standard for treating early hepatocellular cancers. Because of the lack of donors, this option is, however, available to a limited degree only. Curative liver resection is an alternative in this setting. Markus B. Schoenberg, Julian N. Bucher, and coauthors investigated whether liver resection (LR) can yield results that are comparable to those of liver transplantation (LT) (Dtsch Arztebl Int 2017; 114: 519-26).
The authors conducted a meta-analysis of all available studies that compared LT and LR. From the published studies, they analyzed a subgroup consisting of patients with earlier hepatocellular carcinoma (HCC) in compensated cirrhosis, for which LR as well as LT would have been an option. 54 studies including 13 794 patients were included in the subgroup analysis. In this patient population, the researchers compared overall survival after 1, 3, and 5 years, as well as morbidity and mortality in LR and LT.
In patients with early HCC, LT yielded a higher survival rate than LR only after 5 years (66.67% versus 60.35%). After 1 and 3 years the differences did not reach significance. No significant difference in terms of morbidity and mortality was seen in this subgroup.
The researchers concluded that LR in early HCC provides comparably good survival and similar complication rates compared with LT for up to 3 years. Resection should be the objective if the conditions are met. In case of a recurrence, such patients can still be evaluated for transplantation. This strategy could improve the allocation of donor livers. To enable risk stratification, the therapeutic options for the patients should be discussed in a multidisciplinary setting in specialized tumor boards.
Dr. Markus Rentsch