Hepatic Resection for Transplantable Hepatocellular Carcinoma for Patients Within Milan and UCSF Criteria

Background: Liver transplantation is believed to be the best treatment option for selected patients with hepatocellular carcinoma (HCC). However, the shortage of organs and the risk of tumor progression while on the waiting list has hampered this effective treatment modality from being routinely offered. Hence, the second option of hepatic resection must be considered. The aim of this study is to report the results of hepatic resection in transplantable patients. Methods: From 1991 to 2009, 97 patients underwent liver resection for HCC. Thirty patients (31%) met transplant criteria [(Milan/University of California San Franciso (UCSF) Liver Transplant Criteria]. Outcomes after hepatic resection were evaluated with disease-free survival (DFS) and overall survival as the endpoints by stratification of transplant eligibility. Results: There were 30 patients within the UCSF transplant criteria and 16 patients within the Milan transplant criteria. By using either transplant criteria, patients survived an actuarial median survival of 102 months. Patients selected based on the Milan criteria had a median DFS of 55 months and patients selected based on the UCSF criteria had a median DFS of 42 months. Patients who were Child Pugh B (UCSF criteria P < 0.001) and with cirrhosis had a poorer outcome after hepatic resection (UCSF criteria P = 0.011, Milan criteria P = 0.002). Conclusions: Long-term DFS and overall survival may be achieved through hepatic resection for transplantable HCC. This is an effective option and may be regarded as a first-line treatment option. Patients with Child Pugh B or are cirrhotics may benefit more from a transplantation than a resection.