Surgical treatment of hepatocellular carcinoma in North America: Can hepatic resection still be justified?

William C. Chapman, Goran Klintmalm, Alan Hemming, Neeta Vachharajani, Maria B. Majella Doyle, Ron Dematteo, Victor Zaydfudim, Haniee Chung, Keith Cavaness, Robert Goldstein, Ivan Zendajas, Laleh G. Melstrom, David Nagorney, William Jarnagin

Research output: Contribution to journalArticle

Abstract

Background The incidence of hepatocellular cancer (HCC) is increasing dramatically worldwide. Optimal management remains undefined, especially for well-compensated cirrhosis and HCC. Study Design This retrospective analysis included 5 US liver cancer centers. Patients with surgically treated HCC between 1990 and 2011 were analyzed; demographics, tumor characteristics, and survival rates were included. Results There were 1,765 patients who underwent resection (n = 884, 50.1%) or transplantation (n = 881, 49.9%). Overall, 248 (28.1%) resected patients were transplant eligible (1 tumor <5 cm or 2 to 3 tumors all <3 cm, no major vascular invasion); these were compared with 496 transplant patients, matched based on year of transplantation and tumor status. Overall survivals at 5 and 10 years were significantly improved for transplantation patients (74.3% vs 52.8% and 53.7% vs 21.7% respectively, p < 0.001), with greater differences in disease-free survival (71.8% vs 30.1% at 5 years and 53.4% vs 11.7% at 10 years, p < 0.001). Ninety-seven of the 884 (11%) resected patients were within Milan criteria and had cirrhosis; these were compared with the 496 transplantation patients, with similar results to the overall group. On multivariate analysis, type of surgery was an independent variable affecting all survival outcomes. Conclusions The increasing incidence of HCC stresses limited resources. Although transplantation results in better long-term survival, limited donor availability precludes widespread application. Hepatic resection will likely remain a standard therapy in selected patients with HCC. In this large series, only about 10% of patients with cirrhosis were transplant-eligible based on tumor status. Although liver transplantation results are significantly improved compared with resection, transplantation is available only for a minority of patients with HCC.

Original languageEnglish (US)
Pages (from-to)628-637
Number of pages10
JournalJournal of the American College of Surgeons
Volume220
Issue number4
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Chapman, W. C., Klintmalm, G., Hemming, A., Vachharajani, N., Majella Doyle, M. B., Dematteo, R., Zaydfudim, V., Chung, H., Cavaness, K., Goldstein, R., Zendajas, I., Melstrom, L. G., Nagorney, D., & Jarnagin, W. (2015). Surgical treatment of hepatocellular carcinoma in North America: Can hepatic resection still be justified? Journal of the American College of Surgeons, 220(4), 628-637. https://doi.org/10.1016/j.jamcollsurg.2014.12.030