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Surgical Treatment of Hepatocellular Carcinoma: Resection Versus Transplantation

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Difficult Decisions in Hepatobiliary and Pancreatic Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Hepatocellular carcinoma is the second most common cause of cancer mortality worldwide and its incidence is rising in North America, with an estimated 35,000 cases in the U.S. in 2014. The best chance for cure is surgical resection in the form of either segmental removal or whole organ transplantation although recent survival data on radiofrequency ablation approximates surgical resection and could be placed under the new moniker of “thermal resection”. The debate between surgical resection and transplantation focuses on patients with “within Milan criteria” tumors, single tumors, and well compensated cirrhosis who can safely undergo either procedure. Although transplantation historically has had better survival outcomes, early diagnosis, reversal of liver disease, and innovations in patient selection and neo-adjuvant therapies have led to similar 5-year survival. Transplantation clearly has less risk of tumor recurrence but exposes recipients to long term immunosuppression and its side effects. Liver transplantation is also limited by the severe global limit on the supply of organ donors whereas resection is readily available. The current data does not favor one treatment over the other for patients with minimal or no portal hypertension and normal synthetic function. Instead, the decision to resect or transplant for HCC relies on multiple factors including tumor characteristics, biology, geography, co-morbidities, location, organ availability, social support and practice preference.

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Author information

Authors and Affiliations

  1. Department of Surgery, Stanford University, Stanford, CA, USA

    Thomas Pham & Waldo Concepcion

  2. Department of Medicine, Stanford University, Stanford, CA, USA

    Tsuyoshi Todo

  3. Stanford University Medical Center, 750 Welch Rd, Ste. 319 MC 5731, Palo Alto, CA, 94304, USA

    Robert Gish & Waldo Concepcion

Authors
  1. Thomas Pham
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  2. Tsuyoshi Todo
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  3. Robert Gish
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  4. Waldo Concepcion
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Correspondence to Waldo Concepcion .

Editor information

Editors and Affiliations

  1. The University of Chicago, CHICAGO, Illinois, USA

    J. Michael Millis

  2. The University of Chicago, CHICAGO, Illinois, USA

    Jeffrey B. Matthews

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Pham, T., Todo, T., Gish, R., Concepcion, W. (2016). Surgical Treatment of Hepatocellular Carcinoma: Resection Versus Transplantation. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_7

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  • DOI: https://doi.org/10.1007/978-3-319-27365-5_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27363-1

  • Online ISBN: 978-3-319-27365-5

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