Hepatocellular Carcinoma

Resection versus Transplantation

Truman M. Earl; William C. Chapman


Semin Liver Dis. 2013;33(3):282-292. 

In This Article


Hepatic resection and transplantation remain the cornerstone curative therapies for patients with HCC. In patients with early-stage tumors and advanced liver disease, transplantation is clearly the treatment of choice with 5-year survival rates of roughly 70%. Liver transplantation, however, is limited by organ shortage and the inherent risk of transplantation and immunosuppression. In patients without cirrhosis or cirrhotics with preserved liver function and absence of portal hypertension and tumors beyond the Milan criteria, resection remains the treatment of choice when feasible. Although recurrence following resection is common, several recent reports document 5-year overall survival rates following resection for very-early- and early-stage tumors similar to that of liver transplantation. Overall survival rates beyond 5 years, however, may be significantly worse for patients undergoing resection. The essential challenge is determining which therapeutic modality is best for patients with relatively early-stage tumors who could tolerate resection. Numerous factors must be considered including tumor size, multifocality, medical comorbidity, and geographic factors that affect waitlist time and organ availability.