Abstract
The optimal surgical treatment of hepatocellular carcinoma on well-compensated cirrhosis is controversial. Advocates of liver transplantation cite better long-term survival, lower risk of recurrence, and the ability of transplantation to treat both the HCC and the underlying liver cirrhosis. Transplantation, however, is not universally available to all appropriate-risk candidates because of a lack of sufficient organ donors and in addition suffers from the disadvantages of requiring a more complex pre- and postoperative management associated with risks of inaccessibility, noncompliance, and late complications. Resection, by contrast, is much more easily and widely available, avoids many of those risks, is by many accounts as effective at achieving similar long-term survival, and still allows for safe, subsequent liver transplantation in cases of recurrence. Here, arguments are made in favor of resection being easier, safer, simpler, and comparably effective in the treatment of HCC relative to transplantation, and therefore being the optimal initial treatment in cases of hepatocellular carcinoma on well-compensated cirrhosis.
Highlights
Hepatocellular carcinoma (HCC) is the seventh most common cancer worldwide, one of the most common causes of cancer death worldwide, and its incidence is increasing [1,2,3]
While transplantation is clearly better for patients with severe cirrhosis and early HCC, and resection is better than transplantation for resectable but extra-Milan-criteria HCC on mild cirrhosis, on the middle ground—early HCC with mild cirrhosis— wages the debate between transplantation and resection
These results have since been corroborated in subsequent series published in the 2000s, with recurrence rates as low as 2% and 5-year survival rates as high as 89% following liver transplantation for HCC (Table 1)
Summary
Hepatocellular carcinoma (HCC) is the seventh most common cancer worldwide, one of the most common causes of cancer death worldwide, and its incidence is increasing [1,2,3]. The rate of cancer death from primary liver cancer (90% of which is HCC [4]) in the United States has increased by over 40% in recent decades [2]. Risk factors for the development of HCC include hepatitis (most commonly hepatitis B virus (HBV) or hepatitis C virus (HCV)), steatohepatitis, cirrhosis, hepatotoxins, and less commonly hereditary diseases such as hemochromatosis and alpha-1 antitrypsin deficiency. HBV is the most common underlying liver disease, and chronic carriers have a logarithmically increased risk of developing HCC compared to the general population [4]
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