Surgical treatment of hepatocellular carcinoma: comparison of resection and transplantation.

The treatment of hepatocellular carcinoma (HCC) has progressed remarkably over the last years. In patients with good hepatic functional reserve, liver resection should be considered as the therapeutic modality for local control of primary HCC, including a large tumor, or multiple HCCs with vascular invasion. Anatomic resection involves systematic elimination of the main tumor and its minute metastases. In cases with poor hepatic functional reserve, however, liver transplantation may be a better therapeutic option depending on patient age and tumor-related factors. Patients with tumors satisfying the Milan criteria (or its extended criteria) are good candidates for liver transplantation. We analyzed the findings from 100 patients with HCC who underwent living donor liver transplantation. The overall survival at 3 and 5 years after liver transplantation was 79 and 78%, respectively, with a median follow-up of 45 months. The treatment algorithm, based on evidence accrued from published papers, is now available and is useful for determining the therapeutic choice based on the tumor- and liver function-related conditions. Copyright 2008 S. Karger AG, Basel.