Resection and liver transplantation for hepatocellular carcinoma

Semin Liver Dis. 2005;25(2):181-200. doi: 10.1055/s-2005-871198.


Surveillance programs in cirrhotic patients enable the detection of hepatocellular carcinoma (HCC) at early stages, when the tumor is amenable to curative treatments (60% of cases in Japan; 25 to 40% in Europe and the United States). Resection is the mainstay of treatment in noncirrhotic patients and in cirrhotics with well-preserved liver function. In modern series, a perioperative mortality < or = 3% and 5-year survival rates above 50% are expected. Tumor recurrence complicates half of the cases at 3 years, but there is no unquestionable preventive treatment. Liver transplantation provides excellent outcomes applying the Milan criteria (single nodule < or = 5 cm or two or three nodules < or = 3 cm), with 5-year survival rates of 70% and low recurrence rates. Although expansion of selection criteria is appealing, it should be assessed in the setting of prospective well-designed studies. Intention-to-treat analysis has shown that wide extended indications lead to 25% 5-year survival rates. Living donor liver transplantation is having a minor impact in HCC management. Molecular markers are needed to better select the candidates for surgery.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / physiopathology
  • Carcinoma, Hepatocellular / surgery*
  • Carcinoma, Hepatocellular / therapy
  • Chemoembolization, Therapeutic
  • Chemotherapy, Adjuvant
  • Hepatectomy
  • Humans
  • Liver Cirrhosis / complications
  • Liver Neoplasms / mortality
  • Liver Neoplasms / pathology
  • Liver Neoplasms / physiopathology
  • Liver Neoplasms / surgery*
  • Liver Neoplasms / therapy
  • Liver Transplantation*
  • Living Donors
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local
  • Patient Selection
  • Survival Analysis