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Is Resection or Transplantation the ideal Treatment in Patients with Hepatocellular Carcinoma in Cirrhosis if Both Are Possible? A Systematic Review and Metaanalysis

  • Hepatobiliary Tumors
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Abstract

Background

Hepatocellular carcinoma (HCC) is one of the most common neoplasms. Curative treatment options include liver resection (LR) and transplantation (LT). Organ shortage leads to discussion whether resectable HCC in cirrhosis should undergo LT or LR.

Methods

Systematic review and metaanalysis of studies investigating LR and/or LT were performed. Overall survival (OS) and disease-free survival (DFS) were analyzed. Studies reporting 5-year OS of LR versus LT in an intention-to-treat fashion were included in a metaanalysis.

Results

No randomized controlled trial was detected. Seventy publications were eligible for analysis. The 5-year OS revealed a better outcome for LT than LR (60.9 vs. 49.4 %; p < 0.001). Descriptive DFS data indicate superiority of LT at 3 years (62.0 vs. 45.9 %; p < 0.001) and 5 years (58 vs. 33.9 %; p < 0.001). Comparing the 5-year OS of transplantation and resection in a metaanalysis by use of the seven studies with a total of 1,572 patients, no survival advantage could be found (odds ratio, 0.84; 95 % confidence interval, 0.48–1.48; p = 0.55).

Conclusions

A low quality of evidence data suggests the following: resectable HCC should primarily be resected as good alternative to liver transplantation in patients in whom both seem feasible. Randomized controlled trials or at least systematic evaluation of a cohort of patients in which resection and transplantation seem possible should be performed in a registry. This analysis should include intention-to-treat analysis of patients on the waiting list who do not proceed to a potential curative treatment.

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References

  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.

    Article  PubMed  Google Scholar 

  2. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet. 2003;362:1907–17.

    Article  PubMed  Google Scholar 

  3. Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis. 2010;30:61–74.

    Article  CAS  PubMed  Google Scholar 

  4. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226:441–51.

    Article  PubMed  Google Scholar 

  5. Poon RT, Ngan H, Lo CM, Liu CL, Fan ST, Wong J. Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol. 2000;73:109–14.

    Article  CAS  PubMed  Google Scholar 

  6. Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.

    Article  CAS  PubMed  Google Scholar 

  7. Clavien P-A, Lesurtel M, Bossuyt PMM, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13:e11–22.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–38.

    Article  CAS  PubMed  Google Scholar 

  9. Centre for Reviews and Dissemination. CRD’s guidance for undertaking reviews in health care. http://www.york.ac.uk/inst/crd/pdf/Systematic_Reviews.pdf (2009).

  10. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999;30:1434–40.

    Article  CAS  PubMed  Google Scholar 

  11. Bigourdan J-M, Jaeck D, Meyer N, et al. Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl. 2003;9:513–20.

    Article  PubMed  Google Scholar 

  12. Pierie J-PEN, Muzikansky A, Tanabe KK, Ott MJ. The outcome of surgical resection versus assignment to the liver transplant waiting list for hepatocellular carcinoma. Ann Surg Oncol. 2005;12:552–60.

    Article  PubMed  Google Scholar 

  13. Poon RTP, Fan ST, Lo CM, Liu CL, Wong J. Difference in tumor invasiveness in cirrhotic patients with hepatocellular carcinoma fulfilling the Milan criteria treated by resection and transplantation: impact on long-term survival. Ann Surg. 2007;245:51–8.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Shah SA, Cleary SP, Tan JCC, et al. An analysis of resection vs transplantation for early hepatocellular carcinoma: defining the optimal therapy at a single institution. Ann Surg Oncol. 2007;14:2608–14.

    Article  PubMed  Google Scholar 

  15. Del Gaudio M, Ercolani G, Ravaioli M, et al. Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: University of Bologna experience. Am J Transplant. 2008;8:1177–85.

    Article  PubMed  Google Scholar 

  16. Facciuto ME, Rochon C, Pandey M, et al. Surgical dilemma: liver resection or liver transplantation for hepatocellular carcinoma and cirrhosis. Intention-to-treat analysis in patients within and outwith Milan criteria. HPB (Oxford). 2009;11:398–404.

    Article  Google Scholar 

  17. Zhou J, Wang Z, Qiu S-J, et al. Surgical treatment for early hepatocellular carcinoma: comparison of resection and liver transplantation. J Cancer Res Clin Oncol. 2010;136:1453–60.

    Article  PubMed  Google Scholar 

  18. Koniaris LG, Levi DM, Pedroso FE, et al. Is surgical resection superior to transplantation in the treatment of hepatocellular carcinoma? Ann Surg. 2011;254:527-37; discussion 537–8.

    Article  PubMed  Google Scholar 

  19. Iwatsuki S, Starzl TE, Sheahan DG, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg. 1991;214:221–8; discussion 228–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg. 1993;218:145–51.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Michel J, Suc B, Montpeyroux F, et al. Liver resection or transplantation for hepatocellular carcinoma? Retrospective analysis of 215 patients with cirrhosis. J Hepatol. 1997;26:1274–80.

    Article  CAS  PubMed  Google Scholar 

  22. Colella G, Bottelli R, De Carlis L, et al. Hepatocellular carcinoma: comparison between liver transplantation, resective surgery, ethanol injection, and chemoembolization. Transpl Int. 1998;11(Suppl. 1):S193–6.

    Article  PubMed  Google Scholar 

  23. Otto G, Heuschen U, Hofmann WJ, Krumm G, Hinz U, Herfarth C. Survival and recurrence after liver transplantation versus liver resection for hepatocellular carcinoma: a retrospective analysis. Ann Surg. 1998;227:424–32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Philosophe B, Greig PD, Hemming AW, et al. Surgical management of hepatocellular carcinoma: resection or transplantation? J Gastrointest Surg. 1998;2:21–7.

    Article  CAS  PubMed  Google Scholar 

  25. Figueras J, Jaurrieta E, Valls C, et al. Resection or transplantation for hepatocellular carcinoma in cirrhotic patients: outcomes based on indicated treatment strategy. J Am Coll Surg. 2000;190:580–7.

    Article  CAS  PubMed  Google Scholar 

  26. De Carlis L, Giacomoni A, Pirotta V, et al. Treatment of HCC: the role of liver resection in the era of transplantation. Transplant Proc. 2001;33:1453–6.

    Article  PubMed  Google Scholar 

  27. Shabahang M, Franceschi D, Yamashiki N, et al. Comparison of hepatic resection and hepatic transplantation in the treatment of hepatocellular carcinoma among cirrhotic patients. Ann Surg Oncol. 2002;9:881–6.

    Article  PubMed  Google Scholar 

  28. Margarit C, Escartín A, Castells L, Vargas V, Allende E, Bilbao I. Resection for hepatocellular carcinoma is a good option in Child-Turcotte-Pugh class A patients with cirrhosis who are eligible for liver transplantation. Liver Transpl. 2005;11:1242–51.

    Article  PubMed  Google Scholar 

  29. Baccarani U, Benzoni E, Adani GL, et al. Superiority of transplantation versus resection for the treatment of small hepatocellular carcinoma. Transplant Proc. 2007;39:1898–900.

    Article  CAS  PubMed  Google Scholar 

  30. Moon D-B, Lee S-G, Hwang S. Liver transplantation for hepatocellular carcinoma: single nodule with Child-Pugh class A sized less than 3 cm. Dig Dis. 2007;25:320–8.

    Article  PubMed  Google Scholar 

  31. Perry JF, Charlton B, Koorey DJ, et al. Outcome of patients with hepatocellular carcinoma referred to a tertiary centre with availability of multiple treatment options including cadaveric liver transplantation. Liver Int. 2007;27:1240–8.

    PubMed  Google Scholar 

  32. Borie F, Bouvier A-M, Herrero A, et al. Treatment and prognosis of hepatocellular carcinoma: a population based study in France. J Surg Oncol. 2008;98:505–9.

    Article  PubMed  Google Scholar 

  33. Facciuto ME, Koneru B, Rocca JP, et al. Surgical treatment of hepatocellular carcinoma beyond Milan criteria. Results of liver resection, salvage transplantation, and primary liver transplantation. Ann Surg Oncol. 2008;15:1383–91.

    Article  PubMed  Google Scholar 

  34. Obed A, Tsui T-Y, Schnitzbauer AA, et al. Liver transplantation as curative approach for advanced hepatocellular carcinoma: is it justified? Langenbecks Arch Surg. 2008;393:141–7.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Rayya F, Harms J, Bartels M, Uhlmann D, Hauss J, Fangmann J. Results of resection and transplantation for hepatocellular carcinoma in cirrhosis and noncirrhosis. Transplant Proc. 2008;40:933–5.

    Article  CAS  PubMed  Google Scholar 

  36. Nathan H, Mentha G, Marques HP, et al. Comparative performances of staging systems for early hepatocellular carcinoma. HPB. 2009;11:382–90.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Ruzzenente A, Capra F, Pachera S, et al. Is liver resection justified in advanced hepatocellular carcinoma? Results of an observational study in 464 patients. J Gastrointest Surg. 2009;13:1313–20.

    Article  PubMed  Google Scholar 

  38. Sotiropoulos GC, Drühe N, Sgourakis G, et al. Liver transplantation, liver resection, and transarterial chemoembolization for hepatocellular carcinoma in cirrhosis: which is the best oncological approach? Dig Dis Sci. 2009;54:2264–73.

    Article  PubMed  Google Scholar 

  39. Fan H-L, Chen T-W, Hsieh C-B, et al. Liver transplantation is an alternative treatment of hepatocellular carcinoma beyond the Milan criteria. Am J Surg. 2010;200:252–7.

    Article  PubMed  Google Scholar 

  40. Kim SJ, Lee KK, Kim DG. Tumor size predicts the biological behavior and influence of operative modalities in hepatocellular carcinoma. Hepatogastroenterology. 2010;57:121–6.

    PubMed  Google Scholar 

  41. Lee KK, Kim DG, Moon IS, Lee MD, Park JH. Liver transplantation versus liver resection for the treatment of hepatocellular carcinoma. J Surg Oncol. 2010;101:47–53.

    Article  PubMed  Google Scholar 

  42. Canter RJ, Patel SA, Kennedy T, et al. Comparative analysis of outcome in patients with hepatocellular carcinoma exceeding the Milan criteria treated with liver transplantation versus partial hepatectomy. Am J Clin Oncol. 2011;34:466–71.

    Article  PubMed  Google Scholar 

  43. Fan ST, Poon RTP, Yeung C, et al. Outcome after partial hepatectomy for hepatocellular cancer within the Milan criteria. Br J Surg. 2011;98:1292–300.

    Article  CAS  PubMed  Google Scholar 

  44. Cha CH, Ruo L, Fong Y, et al. Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg. 2003;238:315–21; discussion 321–3.

    PubMed Central  PubMed  Google Scholar 

  45. Cherqui D, Laurent A, Mocellin N, et al. Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation. Ann Surg. 2009;250:738–46.

    Article  PubMed  Google Scholar 

  46. Kanematsu T, Furui J, Yanaga K, Okudaira S, Shimada M, Shirabe K. A 16-year experience in performing hepatic resection in 303 patients with hepatocellular carcinoma: 1985-2000. Surgery. 2002;131(1 Suppl.):S153–8.

    Article  PubMed  Google Scholar 

  47. Ercolani G, Grazi GL, Ravaioli M, et al. Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence. Ann Surg. 2003;237:536–43.

    PubMed Central  PubMed  Google Scholar 

  48. Grazi GL, Cescon M, Ravaioli M, et al. Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre. Aliment Pharmacol Ther. 2003;17(Suppl. 2):119–29.

    Article  PubMed  Google Scholar 

  49. Jaeck D, Bachellier P, Oussoultzoglou E, Weber J-C, Wolf P. Surgical resection of hepatocellular carcinoma: post-operative outcome and long-term results in Europe—an overview. Liver Transpl. 2004;10(2 Suppl. 1):S58–63.

    Article  PubMed  Google Scholar 

  50. Sala M, Fuster J, Llovet JM, et al. High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation. Liver Transpl. 2004;10:1294–300.

    Article  PubMed  Google Scholar 

  51. Cucchetti A, Ercolani G, Vivarelli M, et al. Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl. 2006;12:966–71.

    Article  PubMed  Google Scholar 

  52. John AR, Khan S, Mirza DF, Mayer AD, Buckels JAC, Bramhall SR. Multivariate and univariate analysis of prognostic factors following resection in HCC: the Birmingham experience. Dig Surg. 2006;23:103–9.

    Article  PubMed  Google Scholar 

  53. Shah SA, Cleary SP, Wei AC, et al. Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment, and outcomes. Surgery. 2007;141:330–9.

    Article  PubMed  Google Scholar 

  54. Hubert C, Sempoux C, Rahier J, et al. Prognostic risk factors of survival after resection of hepatocellular carcinoma. Hepatogastroenterology. 2007;54:1791–7.

    PubMed  Google Scholar 

  55. Pandey D, Lee K-H, Wai C-T, Wagholikar G, Tan K-C. Long term outcome and prognostic factors for large hepatocellular carcinoma (10 cm or more) after surgical resection. Ann Surg Oncol. 2007;14:2817–23.

    Article  PubMed  Google Scholar 

  56. Shah SA, Wei AC, Cleary SP, et al. Prognosis and results after resection of very large (> or = 10 cm) hepatocellular carcinoma. J Gastrointest Surg. 2007;11:589–95.

    Article  PubMed  Google Scholar 

  57. Takahashi S, Kudo M, Chung H, et al. Outcomes of nontransplant potentially curative therapy for early-stage hepatocellular carcinoma in Child-Pugh stage A cirrhosis is comparable with liver transplantation. Dig Dis. 2007;25:303–9.

    Article  PubMed  Google Scholar 

  58. Taura K, Ikai I, Hatano E, et al. Influence of coexisting cirrhosis on outcomes after partial hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: an analysis of 293 patients. Surgery. 2007;142:685–94.

    Article  PubMed  Google Scholar 

  59. Chirica M, Scatton O, Massault P-P, et al. Treatment of stage IVA hepatocellular carcinoma: should we reappraise the role of surgery? Arch Surg. 2008;143:538–43; discussion 543.

    Article  PubMed  Google Scholar 

  60. Ikegami T, Shimada M, Imura S, et al. The timing of liver transplantation after primary hepatectomy for hepatocellular carcinoma: a special reference to recurrence pattern and Milan criteria. Transplantation. 2008;86:641–6.

    Article  PubMed  Google Scholar 

  61. Scatton O, Zalinski S, Terris B, et al. Hepatocellular carcinoma developed on compensated cirrhosis: resection as a selection tool for liver transplantation. Liver Transpl. 2008;14:779–88.

    Article  PubMed  Google Scholar 

  62. Teh SH, Sheppard BC, Schwartz J, Orloff SL. Model for End-Stage Liver Disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. Am J Surg. 2008;195:697–701.

    Article  PubMed  Google Scholar 

  63. Cucchetti A, Piscaglia F, Caturelli E, et al. Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population. Ann Surg Oncol. 2009;16:413–22.

    Article  PubMed  Google Scholar 

  64. Delis SG, Bakoyiannis A, Tassopoulos N, et al. Hepatic resection for large hepatocellular carcinoma in the era of UCSF criteria. HPB. 2009;11:551–8.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Hsu K-Y, Chau G-Y, Lui W-Y, Tsay S-H, King K-L, Wu C-W. Predicting morbidity and mortality after hepatic resection in patients with hepatocellular carcinoma: the role of Model for End-Stage Liver Disease score. World J Surg. 2009;33:2412–9.

    Article  PubMed  Google Scholar 

  66. Nathan H, Schulick RD, Choti MA, Pawlik TM. Predictors of survival after resection of early hepatocellular carcinoma. Ann Surg. 2009;249:799–805.

    Article  PubMed  Google Scholar 

  67. Park Y-K, Kim B-W, Wang H-J, Kim M-W. Hepatic resection for hepatocellular carcinoma meeting Milan criteria in Child-Turcotte-Pugh class A patients with cirrhosis. Transplant Proc. 2009;41:1691–7.

    Article  PubMed  Google Scholar 

  68. Dahiya D, Wu T-J, Lee C-F, Chan K-M, Lee W-C, Chen M-F. Minor versus major hepatic resection for small hepatocellular carcinoma (HCC) in cirrhotic patients: a 20-year experience. Surgery. 2010;147:676–85.

    Article  PubMed  Google Scholar 

  69. Gassmann P, Spieker T, Haier J, Schmidt F, Mardin WA, Senninger N. Prognostic impact of underlying liver fibrosis and cirrhosis after curative resection of hepatocellular carcinoma. World J Surg. 2010;34:2442–51.

    Article  PubMed  Google Scholar 

  70. Lee JIL, Lee JW, Kim YS, Choi YA, Jeon YS, Cho SG. Analysis of survival in very early hepatocellular carcinoma after resection. J Clin Gastroenterol. 2011;45:366–71.

    Article  CAS  PubMed  Google Scholar 

  71. Muscari F, Foppa B, Carrere N, Kamar N, Peron J-M, Suc B. Resection of a transplantable single-nodule hepatocellular carcinoma in Child-Pugh class A cirrhosis: factors affecting survival and recurrence. World J Surg. 2011;35:1055–62.

    Article  PubMed  Google Scholar 

  72. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9.

    Article  CAS  PubMed  Google Scholar 

  73. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33:1394–403.

    Article  CAS  PubMed  Google Scholar 

  74. Fisher RA, Maroney TP, Fulcher AS, et al. Hepatocellular carcinoma: strategy for optimizing surgical resection, transplantation and palliation. Clin Transplant. 2002;16(Suppl. 7):52–8.

    Article  PubMed  Google Scholar 

  75. Belghiti J, Cortes A, Abdalla EK, et al. Resection prior to liver transplantation for hepatocellular carcinoma. Ann Surg. 2003;238:885–92; discussion 892–3.

    Article  PubMed Central  PubMed  Google Scholar 

  76. Todo S, Furukawa H, Japanese Study Group on Organ Transplantation. Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in Japan. Ann Surg. 2004;240:451–9; discussion 459–61.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Hwang S, Lee S-G, Moon D-B, et al. Salvage living donor liver transplantation after prior liver resection for hepatocellular carcinoma. Liver Transpl. 2007;13:741–6.

    Article  PubMed  Google Scholar 

  78. Vennarecci G, Ettorre GM, Antonini M, et al. First-line liver resection and salvage liver transplantation are increasing therapeutic strategies for patients with hepatocellular carcinoma and Child A cirrhosis. Transplant Proc. 2007;39:1857–60.

    Article  CAS  PubMed  Google Scholar 

  79. Mizuno S, Yokoi H, Shiraki K, et al. Prospective study on the outcome of patients with hepatocellular carcinoma registered for living donor liver transplantation: how long can they wait? Transplantation. 2010;89:650–4.

    Article  PubMed  Google Scholar 

  80. Yao FY, Bass NM, Nikolai B, et al. Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl. 2002;8:873–83.

    Article  PubMed  Google Scholar 

  81. Yao FY, Bass NM, Nikolai B, et al. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. Liver Transpl. 2003;9:684–92.

    Article  PubMed  Google Scholar 

  82. Majno PE, Sarasin FP, Mentha G, Hadengue A. Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: an outcome-oriented decision analysis. Hepatology. 2000;31:899–906.

    Article  CAS  PubMed  Google Scholar 

  83. Mazzaferro V, Llovet JM, Miceli R, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10:35–43.

    Article  PubMed  Google Scholar 

  84. Dhir M, Lyden ER, Smith LM, Are C. Comparison of outcomes of transplantation and resection in patients with early hepatocellular carcinoma: a meta-analysis. HPB. 2012;14:635–45.

    Article  PubMed Central  PubMed  Google Scholar 

  85. McCulloch P, Altman DG, Campbell WB, et al. No surgical innovation without evaluation: the IDEAL recommendations. Lancet. 2009;374:1105–12.

    Article  PubMed  Google Scholar 

  86. European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43.

    Google Scholar 

  87. Greten TF, Malek NP, Schmidt S, et al. Diagnosis of and therapy for hepatocellular carcinoma. Z Für Gastroenterol. 2013;51:1269–326.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Regensburg University Hospital, Regensburg, Germany

    Andrea Proneth MD, Hans J. Schlitt MD, FACS & Andreas A. Schnitzbauer MD

  2. Center for Clinical Studies, Regensburg University Hospital, Regensburg, Germany

    Florian Zeman MSc

  3. Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany

    Andreas A. Schnitzbauer MD

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Proneth, A., Zeman, F., Schlitt, H.J. et al. Is Resection or Transplantation the ideal Treatment in Patients with Hepatocellular Carcinoma in Cirrhosis if Both Are Possible? A Systematic Review and Metaanalysis . Ann Surg Oncol 21, 3096–3107 (2014). https://doi.org/10.1245/s10434-014-3808-1

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