Surgical management of early-stage hepatocellular carcinoma: Resection or transplantation?

Emily C. Bellavance, Kimberly M. Lumpkins, Gilles Mentha, Hugo P. Marques, Lorenzo Capussotti, Carlo Pulitano, Pietro Majno, Paulo Mira, Laura Rubbia-Brandt, Alessandro Ferrero, Luca Aldrighetti, Steven Cunningham, Nadia Russolillo, Benjamin Philosophe, Eduardo Barroso, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: The surgical management of hepatocellular carcinoma in patients with well-compensated cirrhosis is controversial. The purpose of the current study was to compare the outcome of patients with well-compensated cirrhosis and early stage hepatocellular carcinoma treated with initial hepatic resection versus transplantation. Methods: Between 1985 and 2008, 245 patients underwent hepatic resection, and 134 patients underwent liver transplantation for early stage hepatocellular carcinoma. All patients had well-compensated cirrhosis. Prognostic factors were evaluated using univariate and multivariate analyses; survival was calculated using the Kaplan-Meier method. Results: Compared with transplantation, patients undergoing resection had larger tumors and a higher incidence of microscopic vascular invasion. Transplantation was associated with better 5-year disease-free and overall survival compared with resection. Hepatitis status, presence of microscopic vascular invasion, and tumor size were predictors for recurrence, while the presence of microscopic vascular invasion and tumor size conferred an increased risk of death. The disease-free survival advantage with transplantation was more pronounced in hepatitis C patients compared with non-hepatitis and hepatitis B patients. The overall survival advantage with transplantation persisted in cases of solitary lesions ≤3 cm, but was attenuated in patients with a MELD score ≤8. Conclusion: In well-compensated cirrhotic patients with early stage hepatocellular carcinoma, transplantation was associated with longer disease-free and overall survival. Patients undergoing resection did, however, have tumors with more advanced pathologic features. Patients best suited for initial resection as the treatment of hepatocellular carcinoma were those with a MELD score ≤8 without evidence of hepatitis.

Original languageEnglish (US)
Pages (from-to)1699-1708
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume12
Issue number10
DOIs
StatePublished - Oct 2008
Externally publishedYes

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Hepatocellular Carcinoma
Transplantation
Disease-Free Survival
Blood Vessels
Fibrosis
Hepatitis
Neoplasms
Survival
Liver
Hepatitis C
Hepatitis B
Liver Transplantation
Multivariate Analysis
Recurrence
Incidence

Keywords

  • Early stage
  • Hepatocellular carcinoma
  • Outcome
  • Resection
  • Transplantation

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Bellavance, E. C., Lumpkins, K. M., Mentha, G., Marques, H. P., Capussotti, L., Pulitano, C., ... Pawlik, T. M. (2008). Surgical management of early-stage hepatocellular carcinoma: Resection or transplantation? Journal of Gastrointestinal Surgery, 12(10), 1699-1708. https://doi.org/10.1007/s11605-008-0652-2

Surgical management of early-stage hepatocellular carcinoma : Resection or transplantation? / Bellavance, Emily C.; Lumpkins, Kimberly M.; Mentha, Gilles; Marques, Hugo P.; Capussotti, Lorenzo; Pulitano, Carlo; Majno, Pietro; Mira, Paulo; Rubbia-Brandt, Laura; Ferrero, Alessandro; Aldrighetti, Luca; Cunningham, Steven; Russolillo, Nadia; Philosophe, Benjamin; Barroso, Eduardo; Pawlik, Timothy M.

In: Journal of Gastrointestinal Surgery, Vol. 12, No. 10, 10.2008, p. 1699-1708.

Research output: Contribution to journalArticle

Bellavance, EC, Lumpkins, KM, Mentha, G, Marques, HP, Capussotti, L, Pulitano, C, Majno, P, Mira, P, Rubbia-Brandt, L, Ferrero, A, Aldrighetti, L, Cunningham, S, Russolillo, N, Philosophe, B, Barroso, E & Pawlik, TM 2008, 'Surgical management of early-stage hepatocellular carcinoma: Resection or transplantation?', Journal of Gastrointestinal Surgery, vol. 12, no. 10, pp. 1699-1708. https://doi.org/10.1007/s11605-008-0652-2
Bellavance EC, Lumpkins KM, Mentha G, Marques HP, Capussotti L, Pulitano C et al. Surgical management of early-stage hepatocellular carcinoma: Resection or transplantation? Journal of Gastrointestinal Surgery. 2008 Oct;12(10):1699-1708. https://doi.org/10.1007/s11605-008-0652-2
Bellavance, Emily C. ; Lumpkins, Kimberly M. ; Mentha, Gilles ; Marques, Hugo P. ; Capussotti, Lorenzo ; Pulitano, Carlo ; Majno, Pietro ; Mira, Paulo ; Rubbia-Brandt, Laura ; Ferrero, Alessandro ; Aldrighetti, Luca ; Cunningham, Steven ; Russolillo, Nadia ; Philosophe, Benjamin ; Barroso, Eduardo ; Pawlik, Timothy M. / Surgical management of early-stage hepatocellular carcinoma : Resection or transplantation?. In: Journal of Gastrointestinal Surgery. 2008 ; Vol. 12, No. 10. pp. 1699-1708.
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title = "Surgical management of early-stage hepatocellular carcinoma: Resection or transplantation?",
abstract = "Background: The surgical management of hepatocellular carcinoma in patients with well-compensated cirrhosis is controversial. The purpose of the current study was to compare the outcome of patients with well-compensated cirrhosis and early stage hepatocellular carcinoma treated with initial hepatic resection versus transplantation. Methods: Between 1985 and 2008, 245 patients underwent hepatic resection, and 134 patients underwent liver transplantation for early stage hepatocellular carcinoma. All patients had well-compensated cirrhosis. Prognostic factors were evaluated using univariate and multivariate analyses; survival was calculated using the Kaplan-Meier method. Results: Compared with transplantation, patients undergoing resection had larger tumors and a higher incidence of microscopic vascular invasion. Transplantation was associated with better 5-year disease-free and overall survival compared with resection. Hepatitis status, presence of microscopic vascular invasion, and tumor size were predictors for recurrence, while the presence of microscopic vascular invasion and tumor size conferred an increased risk of death. The disease-free survival advantage with transplantation was more pronounced in hepatitis C patients compared with non-hepatitis and hepatitis B patients. The overall survival advantage with transplantation persisted in cases of solitary lesions ≤3 cm, but was attenuated in patients with a MELD score ≤8. Conclusion: In well-compensated cirrhotic patients with early stage hepatocellular carcinoma, transplantation was associated with longer disease-free and overall survival. Patients undergoing resection did, however, have tumors with more advanced pathologic features. Patients best suited for initial resection as the treatment of hepatocellular carcinoma were those with a MELD score ≤8 without evidence of hepatitis.",
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T1 - Surgical management of early-stage hepatocellular carcinoma

T2 - Resection or transplantation?

AU - Bellavance, Emily C.

AU - Lumpkins, Kimberly M.

AU - Mentha, Gilles

AU - Marques, Hugo P.

AU - Capussotti, Lorenzo

AU - Pulitano, Carlo

AU - Majno, Pietro

AU - Mira, Paulo

AU - Rubbia-Brandt, Laura

AU - Ferrero, Alessandro

AU - Aldrighetti, Luca

AU - Cunningham, Steven

AU - Russolillo, Nadia

AU - Philosophe, Benjamin

AU - Barroso, Eduardo

AU - Pawlik, Timothy M.

PY - 2008/10

Y1 - 2008/10

N2 - Background: The surgical management of hepatocellular carcinoma in patients with well-compensated cirrhosis is controversial. The purpose of the current study was to compare the outcome of patients with well-compensated cirrhosis and early stage hepatocellular carcinoma treated with initial hepatic resection versus transplantation. Methods: Between 1985 and 2008, 245 patients underwent hepatic resection, and 134 patients underwent liver transplantation for early stage hepatocellular carcinoma. All patients had well-compensated cirrhosis. Prognostic factors were evaluated using univariate and multivariate analyses; survival was calculated using the Kaplan-Meier method. Results: Compared with transplantation, patients undergoing resection had larger tumors and a higher incidence of microscopic vascular invasion. Transplantation was associated with better 5-year disease-free and overall survival compared with resection. Hepatitis status, presence of microscopic vascular invasion, and tumor size were predictors for recurrence, while the presence of microscopic vascular invasion and tumor size conferred an increased risk of death. The disease-free survival advantage with transplantation was more pronounced in hepatitis C patients compared with non-hepatitis and hepatitis B patients. The overall survival advantage with transplantation persisted in cases of solitary lesions ≤3 cm, but was attenuated in patients with a MELD score ≤8. Conclusion: In well-compensated cirrhotic patients with early stage hepatocellular carcinoma, transplantation was associated with longer disease-free and overall survival. Patients undergoing resection did, however, have tumors with more advanced pathologic features. Patients best suited for initial resection as the treatment of hepatocellular carcinoma were those with a MELD score ≤8 without evidence of hepatitis.

AB - Background: The surgical management of hepatocellular carcinoma in patients with well-compensated cirrhosis is controversial. The purpose of the current study was to compare the outcome of patients with well-compensated cirrhosis and early stage hepatocellular carcinoma treated with initial hepatic resection versus transplantation. Methods: Between 1985 and 2008, 245 patients underwent hepatic resection, and 134 patients underwent liver transplantation for early stage hepatocellular carcinoma. All patients had well-compensated cirrhosis. Prognostic factors were evaluated using univariate and multivariate analyses; survival was calculated using the Kaplan-Meier method. Results: Compared with transplantation, patients undergoing resection had larger tumors and a higher incidence of microscopic vascular invasion. Transplantation was associated with better 5-year disease-free and overall survival compared with resection. Hepatitis status, presence of microscopic vascular invasion, and tumor size were predictors for recurrence, while the presence of microscopic vascular invasion and tumor size conferred an increased risk of death. The disease-free survival advantage with transplantation was more pronounced in hepatitis C patients compared with non-hepatitis and hepatitis B patients. The overall survival advantage with transplantation persisted in cases of solitary lesions ≤3 cm, but was attenuated in patients with a MELD score ≤8. Conclusion: In well-compensated cirrhotic patients with early stage hepatocellular carcinoma, transplantation was associated with longer disease-free and overall survival. Patients undergoing resection did, however, have tumors with more advanced pathologic features. Patients best suited for initial resection as the treatment of hepatocellular carcinoma were those with a MELD score ≤8 without evidence of hepatitis.

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