CHEMOEMBOLIZATION AND ORTHOTOPIC LIVER-TR ANSPLANTATION SURGICAL HEPATOCELLULAR-CARCINOMA

Orthotopic Liver Transplantation (OLT) is the only surgical approach t o non-resectable hepatocellular carcinoma (HCC) but, so far its result s has been poor. During 41 months 112 patients underwent 123 OLT, nine of them had HCC over cirrhosis with a mean age 60 years. The etiology of cirrhosis was: alcohol in 1 and viral hepatitis in 8. Child's grad e: A in 4, B in 5. HCC was: 5 cm or less in 5 and more in 4. According pTNM staging: I in one, II in 5, II in 2 and IVb in 1. Differentiatio n degree: low in 1, moderate in 4, and well in 3 (one case with comple te necrosis after embolization). Eight patients were previously emboli zed with lipiodol, adriamicine and gelfoam, obtaining central necrosis without viable features in periphery. There were no postoperative dea ths, and all the patients were discharged from the hospital. During fo llow up, 3 recurrences were observed, one masive with death of the pat ient after 6 months, and the other was surgically removed (segmentecto my V, VI) after 4 months after OLT without recurrence at 18 month of r esection. In the third case a focal lesions was detected in the U.S. a nd T.C. study, 4 months after OLT, but in wasn't possible to obtain a biopsy because its posterior location; no treatment was made, and she' s alive today. In conclusion, OLT is a good surgical option for non re sectable HCC complicating cirrhosis if the patient is adequately selec ted. Chemoembolization has a good local effect, obtaining tumoral necr osis, but it does not decreases the posterior growth of the tumor in o ther localizations.