Comparison of hepatic resection and transplantation in the treatment of liver cancer
β Scribed by Pr. Henri Bismuth; Laurence Chiche
- Publisher
- John Wiley and Sons
- Year
- 1993
- Tongue
- English
- Weight
- 484 KB
- Volume
- 9
- Category
- Article
- ISSN
- 8756-0437
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β¦ Synopsis
One hundred twenty cirrhotic patients underwent hepatic resection (n = 60) or transplantation (n = 60) for hepatocellular carcinoma.
Overall 3-year survival and survival without recurrence were 50% and 23% in the resection group compared to 47% and 44% in the transplantation group. Several characteristics of the tumors have been studied in order to determine prognostic factors in both groups. Thus, results for 3-year survival without recurrence following transplantation in patients with tumors < 3 cm/one or two nodules (83%) were superior to those following transplantation in patients with tumors larger than 3 cm or three or more nodules (37%) (P < 0.02) and to those following resection (10%). Thus, for patients with small tumors, until now the best candidates for resection, transplantation appears to have significantly better results. Conversely, for larger lesions, with three or more nodules, transplantation, in view of the critical donor situation, is probably not indicated.
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Recurrent hepatitis C after liver transplantation is a universal phenomenon. Graft reinfection occurs rapidly; once it is established, allograft cirrhosis and decompensation rapidly ensue in many patients. Treatment with pegylated interferon plus ribavirin is the standard of care among nontransplant
Resection remains the treatment of choice in liver cancer. In order to avoid liver transplantation in conventionally unresectable tumors ex-situ ("bench" procedure), in-situ and ante-situm resection technique should be preferred whenever feasible. Despite the deficiency of donor organs, a single cen