Hepatocellular Carcinoma

Resection versus Transplantation

Truman M. Earl; William C. Chapman


Semin Liver Dis. 2013;33(3):282-292. 

In This Article

Outcomes of Resection

Although rates of disease recurrence remain high, overall survival has improved over the past several decades, with 5-year patient-survival rates ranging from 25% to 55%, in large part likely due to improved therapy of intrahepatic recurrence.[14,29,30,31] In well-selected patients, those with well-compensated liver disease and small (< 2 cm) solitary tumors without vascular invasion, resection can offer 5-year-survival rates as high as 81% in a recent report by Roayaie et al.[32] This is a very small proportion of the patients who present with HCC; however, these results are similar to those of liver transplantation for early-stage HCC.[3]

Tumor recurrence following resection remains common despite great advances in patient selection, and operative and anesthetic techniques, with 5-year-recurrence rates ranging from 60 to 100% in larger series.[14,31,32,33] Recurrence most commonly occurs within the remnant liver, and clonality analysis of the recurrent tumor indicates that approximately one third result from multicentric occurrence rather than intrahepatic metastasis.[34,35] Numerous factors influence the likelihood of intrahepatic recurrence, including the state of the native liver, tumor size, multicentricity, macro- or microvascular invasion, and in some series, the need for blood transfusion.[31,36,37] There is no standard therapy for intrahepatic recurrence following resection. When feasible, repeat resection should be considered although this approach is often not possible due to multicentric recurrence and/or progression of chronic liver disease.[38]