Should hepatomas be treated with hepatic resection or transplantation?

BACKGROUND. The aim of this collaborative study was to compare the long ter m results of hepatic resection (Hx) with those of orthotopic liver transpla ntation (OLTx) in large numbers of cirrhotic patients with hepatocellular c arcinoma (HCC) and to delineate the roles of these two surgical treatments. METHODS. The databases of the National Cancer Center Hospital in Japan and the University of Pittsburgh Medical Center in the U. S. were exchanged and 294 cirrhotic patients who underwent curative Hx and 270 cirrhotic patient s who underwent curative OLTx were selected for comparison. RESULTS. The mortality rate within 30 days and that within 150 days after H x were significantly lower than those after OLTx (P = 0.001 and P = 0.00007 , respectively). Overall survival was similar between the Hx group and the OLTx group (P = 0.40). When compared in the HCC patients without macroscopi c vascular invasion and lymph node metastases, the overall survival rate af ter OLTx was significantly higher than that after Hx (P = 0.006). However, this difference was not significant between the patients with Child-Pugh Gr ade A tumors in the Hx group and all patients (majority with Child-Pugh Gra de C tumors) in the OLTx group (P = 0.25). Tumor free survival after OLTx w as significantly higher than that after Hx (P < 0.0001), particularly in HC Cs measuring less than or equal to 5 cm, unilobarly distributed tumors, and HCCs with either no or only microscopic vascular invasion. In HCCs measuri ng >5 cm and those with macroscopic vascular invasion, the tumor free survi val rate was similar between the Hx group and the OLTx group. CONCLUSIONS. In the face of organ shortage, HCC developing in a well compen sated cirrhotic liver initially may be treated with Hx. However, the author s believe OLTx should be applied selectively to those patients with tumor r ecurrence and/or progressive hepatic failure. Cancer 1999;86:1151-8. (C) 19 99 American Cancer Society.