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Surgical Treatment of Hepatocellular Carcinoma beyond Milan Criteria. Results of Liver Resection, Salvage Transplantation, and Primary Liver Transplantation

  • Hepatic and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is no clear consensus regarding the best treatment strategy for patients with advanced hepatocellular carcinoma (HCC).

Methods

Patients with cirrhosis and HCC beyond Milan who had undergone liver resection (LR) or primary orthotopic liver transplantation (OLT) between November 1995 and December 2005 were included in this study. Pathological tumor staging was based on the American Liver Tumor Study Group modified Tumor-Node-Metastasis classification.

Results

A total of 23 HCC patients were primarily treated by means of LR, 5 of whom eventually underwent salvage OLT. An additional 32 patients underwent primary OLT. The overall actuarial survival rates at 3 and 5 years were 35% after LR, and 69% and 60%, respectively, after primary OLT. Recurrence-free survival at 5 years was significantly higher after OLT (65%) than after LR (26%). Of the patients who underwent LR, 11 (48%) experienced HCC recurrence only in the liver; 6 of these 11 presented with advanced HCC recurrence, poor medical status, or short disease-free intervals and were not considered for transplantation. Salvage OLT was performed in 5 patients with early stage recurrence (45% of patients with hepatic recurrence after LR and 22% of all patients who underwent LR). At a median of 18 months after salvage OLT, all 5 patients are alive, 4 are free of disease, and 1 developed HCC recurrence 16 months after salvage OLT.

Conclusion

For patients with HCC beyond Milan criteria, multimodality treatment—including LR, salvage OLT, and primary OLT—results in long-term survival in half of the patients. When indicated, LR can optimize the use of scarce donor organs by leaving OLT as a reserve option for early stage HCC recurrence.

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Acknowledgment

The authors thank Nancy Ehrlich for providing editorial assistance in the preparation of this manuscript.

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Authors and Affiliations

  1. Liver Transplant & Hepatobiliary Service, Westchester Medical Center, New York Medical College, 95 Grasslands Road, Valhalla, New York, 10595, USA

    Marcelo E. Facciuto MD, Juan P. Rocca MD, David C. Wolf MD, Leona Kim-Schluger MD, Hoo Chun MD, Michael Marvin MD, Grigory Rozenblit MD, Manuel Rodriguez-Davalos MD & Patricia A. Sheiner MD

  2. Liver Transplant & Hepatobiliary Service, School of Public Health, New York Medical College, Valhalla, New York, USA

    Paul Visintainer PhD

  3. Department of Surgery, UMDNJ-New Jersey Medical School, Newark, New Jersey, USA

    Baburao Koneru MD

  4. Department Pathology, UMDNJ-New Jersey Medical School, Newark, New Jersey, USA

    Kenneth M. Klein MD

Authors
  1. Marcelo E. Facciuto MD
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  2. Baburao Koneru MD
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  3. Juan P. Rocca MD
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  4. David C. Wolf MD
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  5. Leona Kim-Schluger MD
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  6. Paul Visintainer PhD
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  7. Kenneth M. Klein MD
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  8. Hoo Chun MD
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  9. Michael Marvin MD
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Correspondence to Marcelo E. Facciuto MD.

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Facciuto, M.E., Koneru, B., Rocca, J.P. et al. Surgical Treatment of Hepatocellular Carcinoma beyond Milan Criteria. Results of Liver Resection, Salvage Transplantation, and Primary Liver Transplantation. Ann Surg Oncol 15, 1383–1391 (2008). https://doi.org/10.1245/s10434-008-9851-z

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  • DOI: https://doi.org/10.1245/s10434-008-9851-z

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