Erschienen in:
01.06.2009 | SSAT Controversy in GI Surgery Debate
Transplantation Versus Resection for Hepatocellular Carcinoma in the Mild Cirrhotic: Framing the Debate
verfasst von:
Michael A. Choti
Erschienen in:
Journal of Gastrointestinal Surgery
|
Ausgabe 6/2009
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Excerpt
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, with more than one million cases diagnosed worldwide each year. Complex management options confront those treating patients with this disease, shedding light on the importance of a multidisciplinary team for optimal care. Liver resection and liver transplantation are the principle potentially curative treatments for HCC. For those without cirrhosis, surgical resection with partial hepatectomy is the treatment of choice. However, no more than 30% of patients with HCC present with resectable disease, and cirrhosis is present in up to 90%.
1 The presence of extrahepatic disease, lack of sufficient hepatic functional reserve, multifocal disease within the liver, tumors in locations not amenable to resection, and main portal vein involvement, as well as comorbid disease, are all contraindications to resection. For early HCC associated with more advanced cirrhosis, liver transplantation is clearly considered the best treatment option. The most commonly accepted conditions for transplantation for HCC are the Milan criteria: solitary tumor with diameter ≤5 cm or 2–3 tumor nodules with the largest diameter ≤3 cm, and absence of macroscopic vascular invasion or extrahepatic metastasis.
2 …
