Comparison of liver transplantation and liver resection in hepatocelluler carsinoma treatments

Purpose: Hepatocelluler carconima (HCC) is the fifth most common tumorall over the world and is responsible for over 500.000 deaths (1,2). HCC evolving outof chronic liver disease due to viral hepatitis requires treatment not only for thetumor itself, also undelying liver disease has to be treated. The only curativetreatments of HCC are liver transplantation (LT) and liver resection (LR). Althoughsurgical resection is a curative method, presence of cirhosis or multiplicity of tumormay preclude resection. Liver transplantation is a curative method that is effecvitvefor both the underlying liver disease and HCC. In this study we aim to compareresults of LT and LR performed for cirhotic patients in our clinic.Material and Method: Early complications and survivals of 57 patients wentunder LT and 36 patient went under LR for HCC in Dokuz Eylul UniversityMedicine Faculty General Surgery Department Hepatopancreatobiliary Surgery Unitbetween January 1998 and January 2010 were evaluated retrospectively.Results: Mean follow up was 34 months and follow up times were similarbetween 2 groups. In LT gropu hospital stay was significantly longer than LR group(p <0,001). LR was performed singificantly more in HCC patients with Child-Turcotte-Pugh (CTP) class A disease (p =0,001); LT was performed more in CTP Bpatients (p=0,03). Patients with CTP C only went under LT. Postoperativecompications and early operative mortality ranges were similar between 2 groups.Overall survival (p=0,001) was better in LT group than LR group (p=0,001) asdisease-free survival (p=0,00). Local ablation methods performed before LT and LR(chemoembolization, radiafrequency ablation, alcohol injection) were not differentbetween 2 groups. Eighty seven percent of patients went under LT were within theMilan criteria. LT was performed singificantly more for patients within Milancriteria and these patients had better survival (p=0,01) and disease free survival (p=0,00) than LR group. HCC recurrence ranges did not have significant differencebetween LT and LR groups (p<0,232).Conclusion: In this study we determined hospital stay was longer in LT thanLR group. Morbidity and mortality were not different between 2 groups. Patientswith LT had better overall and disease free survival than patients with resection.Consequently LT should be considered as the first choice treatment with its survivaladventages in HCC developed on cirrhotic tissue.