Value of Liver Resection Prior to Salvage Liver Transplantation for Patients with Recurrent Hepatocellular Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Zheng , FAN Jia , ZHOU Jian , QIU Shuangjian , HUANG Xiaowu , SUN Jian , XIAO Yongsheng , SONG Kang , SHEN Zaozhuo.

Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China;

Corresponding author：

Keywords：

Hepatocellular carcinoma; Salvage liver transplantation; Prognosis

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ObjectiveTo evaluate the safety and technical feasibility of salvage liver transplantation (SLT) after liver resection, and its influence on prognosis. MethodsThe clinical data of 289 patients who underwent liver transplantation by cadaveric grafts treating for hepatocellular carcinoma met the UCSF criteria from June 2001 to December 2008 were analyzed retrospectively. Among them, 242 patients underwent primary liver transplantation (PLT, PLT group), and 47 patients underwent SLT for recurrence (SLT group). Perioperative factors and survival were compared between two groups. ResultsThere were no significant differences of age, gender, and pathology of tumor between two groups (P gt;0.05). The operation time in the SLT group was significantly longer than that in the PLT group 〔(7.1±1.8) h versus (6.4±1.4) h， P=0.004〕. The differences of intraoperative blood loss 〔(2 560.5±2 683.6) ml versus (2 042.9±2 006.2) ml， P=0.173〕 and blood transfusion 〔(13.8±12.9) U versus (9.9±12.6) U， P=0.087〕 were not significant between two groups. The mean interval time from resection to transplantation was (32.8±32.4) months. The median followup was 38.7 months, 3year overall and diseasefree survivals were not significantly different (82.3% versus 75.5%, P=0.312; 78.8% versus 70.1%, P=0.755, respectively) between the SLT group and PLT group. According to intentiontotreat analysis, the 3year overall survival in the SLT group was significantly longer than that in the PLT group (88.4% versus 76.2%, P=0.047). ConclusionsIn selected patients, liver resection prior to transplantation neither increases operative morbidity nor impairs prognosis following liver transplantation. SLT after liver resection, can be an alterative treatment for HCC.

Citation： WANG Zheng,FAN Jia,ZHOU Jian,QIU Shuangjian,HUANG Xiaowu,SUN Jian,XIAO Yongsheng,SONG Kang,SHEN Zaozhuo.. Value of Liver Resection Prior to Salvage Liver Transplantation for Patients with Recurrent Hepatocellular Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(4): 362-365. doi: Copy

1.	Zhou J, Fan J, Wu ZQ, et al. Liver transplantation for patients with hepatocellular carcinoma at the Liver Cancer Institute of Fudan University, China [J]. Chin Med J (Engl), 2005, 118(8): 654659.
2.	Graziadei IW, Sandmueller H, Waldenberger P, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome [J]. Liver Transpl, 2003, 9(6): 557563.
3.	Bolondi L, Piscaglia F, Camaggi V, et al. Review article: liver transplantation for HCC. Treatment options on the waiting list [J]. Aliment Pharmacol Ther, 2003, 17 Suppl 2: 145150.
4.	Maddala YK, Stadheim L, Andrews JC, et al. Dropout rates of patients with hepatocellular cancer listed for liver transplantation: outcome with chemoembolization [J]. Liver Transpl, 2004, 10(3): 449455.
5.	Pierie JP, Muzikansky A, Tanabe KK, et al. The outcome of surgical resection versus assignment to the liver transplant waiting list for hepatocellular carcinoma [J]. Ann Surg Oncol, 2005, 12(7): 552560.
6.	Llovet JM, Fuster J, Bruix J. Intentiontotreat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation [J]. Hepatology, 1999, 30(6): 14341440.
7.	李波, 严律南, 袁丁, 等. 肝切除术后复发性肝癌的肝脏移植 [J]. 中国普外基础与临床杂志, 2010, 16(3): 191194.
8.	杨国欢, 樊嘉, 周俭, 等. 肝癌患者肝切除术后再行肝移植与直接行肝移植的疗效评估 [J]. 中华普通外科杂志, 2008, 23(7): 484486.
9.	BennettGuerrero E, Feierman DE, Barclay GR, et al. Preoperative and intraoperative predictors of postoperative morbidity, poor graft function, and early rejection in 190 patients undergoing liver transplantation [J]. Arch Surg, 2001, 136(10): 11771183.
10.	Makuuchi M, Sano K. The surgical approach to HCC: our progress and results in Japan [J]. Liver Transpl, 2004, 10(2 Suppl 1): S46S52.
11.	Adam R, Azoulay D, Castaing D, et al. Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? [J]. Ann Surg, 2003, 238(4): 508518.
12.	Belghiti J, Cortes A, Abdalla EK, et al. Resection prior to liver transplantation for hepatocellular carcinoma [J]. Ann Surg, 2003, 238(6): 885892.
13.	Poon RT, Fan ST. Is primary resection and salvage transplantation for hepatocellular carcinoma a reasonable strategy? [J]. Ann Surg, 2004, 240(5): 925928.
14.	Del Gaudio M, Ercolani G, Ravaioli M, et al. Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: University of Bologna experience [J]. Am J Transplant, 2008, 8(6): 11771185.
15.	Margarit C, Escartín A, Castells L, et al. Resection for hepatocellular carcinoma is a good option in ChildTurcottePugh class A patients with cirrhosis who are eligible for liver transplantation [J]. Liver Transpl, 2005, 11(10): 12421251.
16.	Schwartz M, Dvorchik I, Roayaie S, et al. Liver transplantation for hepatocellular carcinoma: extension of indications based on molecular markers [J]. J Hepatol, 2008, 49(4): 581588.
17.	Sala M, Fuster J, Llovet JM, et al; Barcelona Clinic Liver Cancer (BCLC) Group. High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation [J]. Liver Transpl, 2004, 10(10): 12941300.

1. Zhou J, Fan J, Wu ZQ, et al. Liver transplantation for patients with hepatocellular carcinoma at the Liver Cancer Institute of Fudan University, China [J]. Chin Med J (Engl), 2005, 118(8): 654659.
2. Graziadei IW, Sandmueller H, Waldenberger P, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome [J]. Liver Transpl, 2003, 9(6): 557563.
3. Bolondi L, Piscaglia F, Camaggi V, et al. Review article: liver transplantation for HCC. Treatment options on the waiting list [J]. Aliment Pharmacol Ther, 2003, 17 Suppl 2: 145150.
4. Maddala YK, Stadheim L, Andrews JC, et al. Dropout rates of patients with hepatocellular cancer listed for liver transplantation: outcome with chemoembolization [J]. Liver Transpl, 2004, 10(3): 449455.
5. Pierie JP, Muzikansky A, Tanabe KK, et al. The outcome of surgical resection versus assignment to the liver transplant waiting list for hepatocellular carcinoma [J]. Ann Surg Oncol, 2005, 12(7): 552560.
6. Llovet JM, Fuster J, Bruix J. Intentiontotreat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation [J]. Hepatology, 1999, 30(6): 14341440.
7. 李波, 严律南, 袁丁, 等. 肝切除术后复发性肝癌的肝脏移植 [J]. 中国普外基础与临床杂志, 2010, 16(3): 191194.
8. 杨国欢, 樊嘉, 周俭, 等. 肝癌患者肝切除术后再行肝移植与直接行肝移植的疗效评估 [J]. 中华普通外科杂志, 2008, 23(7): 484486.
9. BennettGuerrero E, Feierman DE, Barclay GR, et al. Preoperative and intraoperative predictors of postoperative morbidity, poor graft function, and early rejection in 190 patients undergoing liver transplantation [J]. Arch Surg, 2001, 136(10): 11771183.
10. Makuuchi M, Sano K. The surgical approach to HCC: our progress and results in Japan [J]. Liver Transpl, 2004, 10(2 Suppl 1): S46S52.
11. Adam R, Azoulay D, Castaing D, et al. Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? [J]. Ann Surg, 2003, 238(4): 508518.
12. Belghiti J, Cortes A, Abdalla EK, et al. Resection prior to liver transplantation for hepatocellular carcinoma [J]. Ann Surg, 2003, 238(6): 885892.
13. Poon RT, Fan ST. Is primary resection and salvage transplantation for hepatocellular carcinoma a reasonable strategy? [J]. Ann Surg, 2004, 240(5): 925928.
14. Del Gaudio M, Ercolani G, Ravaioli M, et al. Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: University of Bologna experience [J]. Am J Transplant, 2008, 8(6): 11771185.
15. Margarit C, Escartín A, Castells L, et al. Resection for hepatocellular carcinoma is a good option in ChildTurcottePugh class A patients with cirrhosis who are eligible for liver transplantation [J]. Liver Transpl, 2005, 11(10): 12421251.
16. Schwartz M, Dvorchik I, Roayaie S, et al. Liver transplantation for hepatocellular carcinoma: extension of indications based on molecular markers [J]. J Hepatol, 2008, 49(4): 581588.
17. Sala M, Fuster J, Llovet JM, et al; Barcelona Clinic Liver Cancer (BCLC) Group. High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation [J]. Liver Transpl, 2004, 10(10): 12941300.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of Liver Resection Prior to Salvage Liver Transplantation for Patients with Recurrent Hepatocellular Carcinoma

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