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Should hepatomas be treated with hepatic resection or transplantation?

Yamamoto, J and Iwatsuki, S and Kosuge, T and Dvorchik, I and Shimada, K and Marsh, JW and Yamasaki, S and Starzl, TE (1999) Should hepatomas be treated with hepatic resection or transplantation? Cancer, 86 (7). 1151 - 1158. ISSN 0008-543X

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Abstract

BACKGROUND: The aim of this collaborative study was to compare the long term results of hepatic resection (Hx) with those of orthotopic liver transplantation (OLTx) in large numbers of cirrhotic patients with hepatocellular carcinoma (HCC) and to delineate the roles of these two surgical treatments. METHODS: The databases of the National Cancer Center Hospital in Japan and the University of Pittsburgh Medical Center in the U. S. were exchanged and 294 cirrhotic patients who underwent curative Hx and 270 cirrhotic patients who underwent curative OLTx were selected for comparison. RESULTS: The mortality rate within 30 days and that within 150 days after Hx were significantly lower than those after OLTx (P = 0.001 and P = 0.00007, respectively). Overall survival was similar between the Hx group and the OLTx group (P = 0.40). When compared in the HCC patients without macroscopic vascular invasion and lymph node metastases, the overall survival rate after OLTx was significantly higher than that after Hx (P = 0.006). However, this difference was not significant between the patients with Child-Pugh Grade A tumors in the Hx group and all patients (majority with Child-Pugh Grade C tumors) in the OLTx group (P = 0.25). Tumor free survival after OLTx was significantly higher than that after Hx (P < 0.0001), particularly in HCCs measuring </=5 cm, unilobarly distributed tumors, and HCCs with either no or only microscopic vascular invasion. In HCCs measuring > 5 cm and those with macroscopic vascular invasion, the tumor free survival rate was similar between the Hx group and the OLTx group. CONCLUSIONS: In the face of organ shortage, HCC developing in a well compensated cirrhotic liver initially may be treated with Hx. However, the authors believe OLTx should be applied selectively to those patients with tumor recurrence and/or progressive hepatic failure.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Yamamoto, J
Iwatsuki, S
Kosuge, T
Dvorchik, I
Shimada, K
Marsh, JW
Yamasaki, S
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 October 1999
Date Type: Publication
Journal or Publication Title: Cancer
Volume: 86
Number: 7
Page Range: 1151 - 1158
Institution: University of Pittsburgh
Refereed: Yes
Uncontrolled Keywords: Carcinoma, Hepatocellular, Disease-Free Survival, Female, Hepatectomy, Humans, Liver Cirrhosis, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Survival Rate
ISSN: 0008-543X
Funders: NIDDK NIH HHS (R01 DK029961-19), NIDDK NIH HHS (DK-29961)
Other ID: uls-drl:31735062120153, Starzl CV No. 2105
Date Deposited: 08 Apr 2010 17:36
Last Modified: 12 Oct 2017 09:55
URI: http://d-scholarship.pitt.edu/id/eprint/5491

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