Hepatoma of the liver - resection or transplantation?

Jonas, Sven; Bechstein, Wolf O.

doi:10.1007/s004230050261

Cited by 23 publications

(17 citation statements)

References 50 publications

(42 reference statements)

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“…Trotz intensivierter Screening-Versuche sind zum Zeitpunkt der Diagnose viele Patienten nicht mehr operabel. Je nach Patientenkollektiv variiert die Resektionsrate zwischen 8 und 40% [37]. Die größten publizierten Serien sind in ihrer prognostischen Aussage sehr inhomogen (Tab.…”

Section: Ergebnisse Der Leberresektionunclassified

“…Entscheidend für die Langzeitprognose nach Lebertransplantation bei HCC ist die klare Definition von Selektionskriterien, da neben extrahepatischen Tumormanifestationen vor allem die Tumorgröße und die Wahrscheinlichkeit einer Gefäßinfiltration die Prognose bestimmen [37]. Viele größere Zentren sehen eine Indikation bei einem Soltärtumor <5 cm oder bei bis zu 3 Tumorknoten <3 cm, wobei keine Gefäßinfil-tration nachweisbar sein sollte.…”

Section: Lebertransplantation Als Behandlungsalternativeunclassified

“…Kleinere Tumorbefunde, die aufgrund einer deutlich eingeschränkten Leberfunktion nicht mehr resektabel erscheinen, werden durch die Transplantation einem formal kurativen Therapieansatz zugänglich. Dieser senkt im Vergleich zur Resektion die postoperative Mortalität und Morbidität bei Zirrhoselebern deutlich [37]. Bei standardisierter Indikationsstellung weist die Lebertransplantation mit 5-Jahres-Überlebensraten von 58-80% (Tab.…”

Section: Lebertransplantation Als Behandlungsalternativeunclassified

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Chirurgische Therapie von Präkanzerosen und frühen Karzinomen der Leber

Ulrich¹,

Jonas²,

Steinmüller³

et al. 2002

Visc Med

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Surgical Therapy of Precancerous Lesions and Early Carcinomas of the Liver The only potentially curative treatment for liver malignancy is still limited to surgical procedures, i.e. liver resection or transplantation. Since the tumors are often discovered in advanced stages, identification of risk groups with precancerous lesions is of crucial importance. A careful screening allows an early diagnosis of malignancy with an improved long-term prognosis. Dysplastic lesions in liver cirrhosis and other precancerous conditions like hereditary hemochromatosis and liver adenoma increase the risk for the development of hepatocellular carcinoma (HCC). The prevalence of cholangiocellular carcinoma (CCC) is significantly higher in patients with primary sclerosing cholangitis (PSC) and polycystic liver disease. New imaging techniques allow a highly specific discrimination of benign lesions; histopathological evidence of liver cell dysplasia may also be helpful. Due to standardized patient selection, the results of liver resection for HCC have improved especially in non-cirrhotic patients and in patients with tumors ≤3 cm. Thus, 5-year survival rates over 50% can be achieved. Liver resection for adenoma and unilobar Caroli’s disease has an excellent prognosis, whereas only 20% of patients with CCC are still alive after 5 years. Liver transplantation is a treatment option for small HCCs in cirrhosis, since beside the curative intention the underlying disease is also cured. For solitary tumors <5 cm or up to three lesions <3 cm, 5-year survival rates are between 58 and 80%. PSC, bilobar Caroli’s disease and hereditary metabolic diseases as facultative precancerous disorders have even better results. Survival rates of CCC after transplantation have also increased due to new neoadjuvant treatment options and limitation to early stages. The scarce donor organ resources, however, limit the availability of liver transplantation as a treatment option for many patients, and tumor progress of those on the waiting list remains a major problem. Living-donor liver transplantation may prove to be very beneficial in some of these patients.

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Section: Ergebnisse Der Leberresektionunclassified

Section: Lebertransplantation Als Behandlungsalternativeunclassified

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Chirurgische Therapie von Präkanzerosen und frühen Karzinomen der Leber

Ulrich¹,

Jonas²,

Steinmüller³

et al. 2002

Visc Med

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“…Tumor biopsy is not required, because test results can be misleading and are falsely negative in at least 10% of cases, moreover, a tumor dissemination by biopsy is discussed. Preoperative diagnostic imaging still fails to reliably predict the most important prognostic factor, vascular infiltration [22]. Grade I trabecular, only minor cellular atypical signs, bile production, difficult to differentiate from normal parenchyma or adenoma Grade II tubular, pseudoglandular or acinous, modest cellular atypical signs, often bile production Grade III in majority solid with loss of organized structure, modest to high cellular atypical signs, rarely bile production, often vascular infiltration Grade VI solid with complete loss of organized structure, highly dysplastic cellular signs, mismatch of nuclear/plasma relation, very rarely bile production, HCC are heterogeneous tumors with different grades of differentiation in one tumor.…”

Section: Diagnostic Steps Influencing Therapeutic Decisionmentioning

confidence: 99%

“…DNA ploidity and microsatelite instability could give further prognostic hints for patient selection for transplantation and multimodal treatment [22]. Bismuth advocated the Child criteria as landmarks for the safe extent of resection possible in cirrhotic livers: Child A: 50% parenchyma, Child B: 25% parenchyma, Child C: no resection (enucleation) [26].…”

Section: Resectionmentioning

confidence: 99%

Multimodal Treatment of Hepatocellular Carcinoma (HCC)

Sturm¹,

Keese²

2004

Oncol Res Treat

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Screening of patients at risk for hepatocellular carcinomas (HCC) and preventive virustatic therapy are the first steps in a multimodal treatment concept, because delayed detection leads to a poor prognosis with median survival of <10 months. Surgical resection of HCC is still the treatment of choice in patients with good residual liver function, however, recurrence-free 5-year survival after curative resection is low (33%). In patients with cirrhosis, only 25% of HCC are resectable, limited by low hepatic functional reserve. HCC in patients with non-cirrhotic livers are the domain of extended resections. In newer reports, transplantation in patients with cirrhosis is rated more positively when restricted to patients with solitary nodules <5 cm or up to 3 tumors <3 cm. A new option in HCC therapy are the local methods for tumor ablation, preferably radiofrequency ablation (RFA), especially in patients with limited liver function, non-resectable or multifocal tumors. A new horizon is opened combining these options and multimodal approaches with transarterial chemoembolisation (TACE). This trend to multimodal approaches promises a yet unknown improvement in the prognosis of patients with HCC. Controlled randomized studies comparing and validating the different methods and defining combined treatments according to liver function and tumor stage are eagerly awaited.

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