Early Hepatocellular Carcinoma: Transplantation versus Resection: The Case for Liver Resection

Abstract

The optimal surgical treatment of hepatocellular carcinoma on well-compensated cirrhosis is controversial. Advocates of liver transplantation cite better long-term survival, lower risk of recurrence, and the ability of transplantation to treat both the HCC and the underlying liver cirrhosis. Transplantation, however, is not universally available to all appropriate-risk candidates because of a lack of sufficient organ donors and in addition suffers from the disadvantages of requiring a more complex pre- and postoperative management associated with risks of inaccessibility, noncompliance, and late complications. Resection, by contrast, is much more easily and widely available, avoids many of those risks, is by many accounts as effective at achieving similar long-term survival, and still allows for safe, subsequent liver transplantation in cases of recurrence. Here, arguments are made in favor of resection being easier, safer, simpler, and comparably effective in the treatment of HCC relative to transplantation, and therefore being the optimal initial treatment in cases of hepatocellular carcinoma on well-compensated cirrhosis.

Meta-analysis of surgical resection and radiofrequency ablation for early hepatocellular carcinoma

“…Theoretically, the best treatment is liver transplantation [8-13]. However, the limited availability of suitable living donors, as well as an increased waiting period, has raised the demand for treatment strategies of early HCC, such as SR and local ablation therapies.…”

Survival after treatment with curative intent for hepatocellular carcinoma among patients with vs without non‐alcoholic fatty liver disease

“…Patients who receive OLT, resection or RFA for HCC can achieve a 5‐year survival of 50%‐75%, 50%‐93% or 33%‐40%, respectively . While treatment algorithms have provided guidance on the selection of appropriate candidates for curative treatments, preference for OLT, resection, or RFA remains debatable and largely contingent on the patient's clinical characteristics, liver function and tumour biology . Large studies to compare the three major types of curative treatments, and by HCC aetiology, have yet to be performed …”

Radiofrequency ablation versus hepatic resection for the treatment of early-stage hepatocellular carcinoma meeting Milan criteria: a systematic review and meta-analysis

“…Theoretically, the best treatment is liver transplantation [8-13], which offers the potential to both resect the entire potentially tumor-bearing liver and eliminate the cirrhosis. However, the limited availability of suitable living donors, high cost, as well as an increased waiting period, has raised the demand for treatment strategies of early HCC, such as HR and RFA.…”