Liver transplantation or liver resection for cirrhotic patients with hepatocellular carcinoma: comparison of long-term survival

Abstract

Background: Liver transplantation(LT) and liver resection(LR) represent curative treatment options for hepatocellular carcinoma(HCC) in patients with liver cirrhosis. With regard to improvements in oncologic liver surgery, we compared outcomes between historical and more recent patient cohorts offered LT and LR. Methods: All patients with HCC and cirrhosis who underwent LT or LR between 1989 and 2011 were evaluated. Overall survival(OS) was analyzed focusing on changes between different time periods and relevance of tumor burden, as classified by Milan criteria(MC). Results: In total, 364 and 141 patients underwent LT and LR for HCC in cirrhosis, respectively. Postoperative morbidity (52% vs. 14%, p<.0001), but not mortality (6% vs. 3%, p=.06), was higher after LR than after LT. In the period 1989–2004, OS was significantly higher in patients who underwent LT compared to LR, both within MC (5-year OS: 77% vs. 36%, p<.0001) and beyond MC (5-year OS: 45% vs. 19%, p=.016). Interestingly, in the period 2005–2011, OS was comparable between LT and LR both within MC (5-year OS: 73% vs. 53%, p=.122) and beyond MC (5-year OS: 33% vs. 38%, p=.370). Conclusion: We noted improved outcomes after partial hepatectomy in recent years, comparable to stable results after LT. These improvements may be explained by advances in surgical techniques and improved perioperative management. Therefore, in the light of organ shortage, patients with HCC and compensated cirrhosis should be evaluated for liver resection in specialized hepatobiliary centers.