scholarly journals The Treatment Effect of Liver Transplantation versus Liver Resection for HCC: A Review and Future Perspectives

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3730
Author(s):  
Berend R. Beumer ◽  
Roeland F. de Wilde ◽  
Herold J. Metselaar ◽  
Robert A. de Man ◽  
Wojciech G. Polak ◽  
...  

For patients presenting with hepatocellular carcinoma within the Milan criteria, either liver resection or liver transplantation can be performed. However, to what extent either of these treatment options is superior in terms of long-term survival is unknown. Obviously, the comparison of these treatments is complicated by several selection processes. In this article, we comprehensively review the current literature with a focus on factors accounting for selection bias. Thus far, studies that did not perform an intention-to-treat analysis conclude that liver transplantation is superior to liver resection for early-stage hepatocellular carcinoma. In contrast, studies performing an intention-to-treat analysis state that survival is comparable between both modalities. Furthermore, all studies demonstrate that disease-free survival is longer after liver transplantation compared to liver resection. With respect to the latter, implications of recurrences for survival are rarely discussed. Heterogeneous treatment effects and logical inconsistencies indicate that studies with a higher level of evidence are needed to determine if liver transplantation offers a survival benefit over liver resection. However, randomised controlled trials, as the golden standard, are believed to be infeasible. Therefore, we suggest an alternative research design from the causal inference literature. The rationale for a regression discontinuity design that exploits the natural experiment created by the widely adopted Milan criteria will be discussed. In this type of study, the analysis is focused on liver transplantation patients just within the Milan criteria and liver resection patients just outside, hereby ensuring equal distribution of confounders.

HPB ◽  
2009 ◽  
Vol 11 (5) ◽  
pp. 398-404 ◽  
Author(s):  
Marcelo E. Facciuto ◽  
Caroline Rochon ◽  
Mahima Pandey ◽  
Manuel Rodriguez-Davalos ◽  
Susana Samaniego ◽  
...  

2007 ◽  
Vol 39 (10) ◽  
pp. A43-A44
Author(s):  
M.C. Dezza ◽  
V. Corno ◽  
A. Lucianetti ◽  
M. Zambelli ◽  
M. Guizzetti ◽  
...  

HPB ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. 1295-1302 ◽  
Author(s):  
Chetana Lim ◽  
Chady Salloum ◽  
Eylon Lahat ◽  
Dobromir Sotirov ◽  
Rony Eshkenazy ◽  
...  

2008 ◽  
Vol 48 ◽  
pp. S77-S78
Author(s):  
A.W. Avolio ◽  
M. Siciliano ◽  
S. Agnes ◽  
A. Gasbarrini ◽  
G. Caracciolo ◽  
...  

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 355-355 ◽  
Author(s):  
Peter Tae Wan Kim ◽  
Jihyun Jang ◽  
Sandra Fischer ◽  
Paul David Greig ◽  
Steven Gallinger ◽  
...  

355 Background: Liver resection for multifocal hepatocellular carcinoma (HCC) is controversial. This study was conducted to outline our institution’s experience with liver resection for multifocal HCC. Methods: A retrospective review of patients who underwent liver resections from 1992 to 2011 for histologically confirmed hepatocellular carcinoma was performed. Multifocal disease was defined as more than 1 histologically proven HCC found in the liver resection specimens. Results: Of the 386 liver resections performed for HCC, 47 were performed for multifocal disease. Mean age was 60+11 years, and most patients (92%) had chronic liver disease. Hepatitis B was the most common etiology (60%), followed by hepatitis C (26%), and other etiologies (15%). Most patients were Child’s class A (89%). Most patients had intermediate Barcelona Clinic Liver Cancer (BCLC) stage (stage B) tumors (81%) and a minority of patients had early stage tumors (BCLC stage A, 19%). Major hepatectomy (>2 segments) was performed in 87% with an in hospital mortality of 6.4%. Major complications (Clavien-Dindo scale >3) occurred in 4 patients (9%). Median length of stay was 7 days and the rate of liver failure was 4.3%. Mean tumor number was 3+2 and the size of the largest lesion was 5+3 cm. Cirrhosis was present in 51% of patients. Majority of tumors were moderately differentiated (60%) and vascular invasion was present in 42%. The recurrence rate was 57% and the liver was the most common site of recurrence (81%). Treatment of recurrences occurred in 74% of patients: ablation (33%), chemotherapy (11%), transarterial chemoembolization (11%), resection (7.4%), sorafenib/radiation (7.4%) and transplantation (3.7%). Median disease free interval was 8 months and the overall survival was 18 months Conclusions: Liver resection for multifocal HCC can be performed safely in patients with chronic liver disease. Long term survival can be achieved in these patients and it should be considered as an option.


Hepatology ◽  
2017 ◽  
Vol 65 (6) ◽  
pp. 1979-1990 ◽  
Author(s):  
Min Woo Lee ◽  
Steven S. Raman ◽  
Nazanin H. Asvadi ◽  
Surachate Siripongsakun ◽  
Robert M. Hicks ◽  
...  

2018 ◽  
Vol 39 (2) ◽  
pp. 361-370 ◽  
Author(s):  
Zhiwei Li ◽  
Zhenzhen Gao ◽  
Jie Xiang ◽  
Jie Zhou ◽  
Sheng Yan ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document