Digestive Diseases and Sciences

, Volume 54, Issue 10, pp 2264–2273 | Cite as

Liver Transplantation, Liver Resection, and Transarterial Chemoembolization for Hepatocellular Carcinoma in Cirrhosis: Which Is the Best Oncological Approach?

  • Georgios C. Sotiropoulos
  • Nina Drühe
  • George Sgourakis
  • Ernesto P. Molmenti
  • Susanne Beckebaum
  • Hideo A. Baba
  • Gerald Antoch
  • Philip Hilgard
  • Arnold Radtke
  • Fuat H. Saner
  • Silvio Nadalin
  • Andreas Paul
  • Massimo Malagó
  • Christoph E. Broelsch
  • Hauke Lang
Original Article


The aim of the study was to evaluate our institutional experience with monotherapies for hepatocellular carcinoma (HCC) in the setting of cirrhosis. A retrospective cohort study was carried out at the tertiary care academic referral center and involved 185 consecutive HCC patients with cirrhosis and no previous treatment who underwent resection (n = 61), transarterial chemoembolization (TACE) (n = 64), or liver transplantation (LT) (n = 60). Long-term survival and survival according to the Milan criteria were the main outcomes measured. Median survival after resection, TACE, and LT was 11, 14, and 23 months, respectively. Five-year cumulative survival after resection, TACE, and LT was 23, 10, and 59%, respectively (P = 0.001). Five-year cumulative disease-free survival after resection and LT was 15% and 77%, respectively (P = 0.002). The presence of complications in the resection group (P = 0.004), MELD score (P = 0.0003), and maximum tumor diameter (P = 0.05) in the TACE group, and tumor grade (P = 0.01) and complications (P = 0.004) in the LT group were found to be independent predictors of survival. Five-year survival for patients within the Milan criteria after resection, TACE, and LT was 26, 37, and 66%, respectively. Five-year survival for patients outside the Milan criteria for patients undergoing LT was 53%. The results suggest that LT represents the best oncological treatment option for patients with HCC in the setting of cirrhosis, even for those beyond the Milan criteria. Considering the scarcity of available organs, liver resection remains the best alternative option. TACE remains a potential therapy in patients within the Milan criteria, where it may be more beneficial than resection.


Hepatocellular carcinoma Liver resection Liver surgery Liver transplantation Transarterial chemoembolization Patient outcome Tumor recurrence Cirrhosis 



Alpha fetoprotein


Hepatitis B virus


Hepatocellular carcinoma


Hepatitis C virus


Liver transplantation


Model for end-stage liver disease


Not significant


Transarterial chemoembolization


Tumor Nodes Metastasis


Union International Contre le Cancer


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Georgios C. Sotiropoulos
    • 1
    • 2
  • Nina Drühe
    • 1
  • George Sgourakis
    • 1
  • Ernesto P. Molmenti
    • 1
  • Susanne Beckebaum
    • 1
  • Hideo A. Baba
    • 3
  • Gerald Antoch
    • 4
  • Philip Hilgard
    • 5
  • Arnold Radtke
    • 1
  • Fuat H. Saner
    • 1
  • Silvio Nadalin
    • 1
  • Andreas Paul
    • 1
  • Massimo Malagó
    • 1
  • Christoph E. Broelsch
    • 1
  • Hauke Lang
    • 1
  1. 1.Department of General, Visceral and Transplantation SurgeryUniversity Hospital EssenEssenGermany
  2. 2.Department of General and Abdominal SurgeryUniversity Hospital, Johannes Gutenberg University of MainzMainzGermany
  3. 3.Institute of Pathology and NeuropathologyUniversity Hospital EssenEssenGermany
  4. 4.Department of Diagnostic and Interventional RadiologyUniversity Hospital EssenEssenGermany
  5. 5.Department of Gastroenterology and HepatologyUniversity Hospital EssenEssenGermany

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