Hepatocellular carcinoma. Resection versus transplantation

For decision of adequate surgical therapy and comparison of results differe ntiation of hepatocellular carcinomas (HCC) in cirrhotic and noncirrhotic L ivers is important. Liver resection is the treatment of choice for HCC in n oncirrhotic liver. Between 4/94 and 8/99 we treated 54 patients with hepato cellular carcinoma (HCC) by subtotal hepatic resection (n = 40) and orthoto pic liver transplantation (n = 14). Overall 1- and 3-year survival rates of the resection group were 45 and 25 % (median follow up: 3.5 years). One-ye ar survival in the, transplantation group was 72 % (median follow up: 2.2 y ears). In patients with HCC in cirrhosis in UICC stage I to III the optimal therapy is a controversial issue. In these patients the results after live r resection are poor due to high operative mortality and recurrence (3-year recurrence-free survival: 30 %). Regarding the literature, liver transplan tation is the treatment of choice in small (< 3-5 cm, less than or equal to 2 tumors) HCCs ari sing in cirrhosis with better outcome compared to resec tion. The data in the literature report 3-year-survival rates after liver t ransplantation of 60-80 %. However, consequent patient selection is necessa ry for this treatment modality. Due to the limited donor resources liver tr ansplantation is rarely justified in advanced tumors.