This is my february highlight from the journal HPB
In the September issue of HPB we published a meta-analysis which showed that outcomes for patients with HCC from all causes were better after liver transplantation than after liver resection but that this benefit disappeared when an intention to treat analysis was performed (Dhir et al., HPB 2012; 14 (9), 635–645).
In the current issue of HPB, Sogawa and colleagues from the Mount Sinai Medical Center present evidence based on patients with hepatitis C virus associated solitary HCC. This group has been the most contentious regarding whether it is better to undertake resection or to transplant the liver. Their study shows that a third of patients with HCV-associated solitary HCC who were listed for transplant died or progressed outside of transplant criteria while waiting for liver transplantation. The intention to treat analysis showed a superior survival of 62 months versus 31 months for patients who underwent liver resection compared with those that underwent liver transplantation; this difference did not achieve statistical significance presumably because the numbers of patients were relatively small.
Recurrence rates for HCC were significantly higher in resected than transplanted patients but almost all recurrences were intrahepatic and a third underwent salvage transplantation and 40% underwent either repeat resection or ablation.
The decision about how best to manage HCC ultimately depends on the availability of livers for transplantation, the status of the patients’ liver function and the outcomes of the individual centre. However, this study clearly shows that, based on intention to treat analyses, resection of solitary HCC on a background of hepatitis C virus is a reasonable strategy to adopt in a landscape with limited organ availability for transplantation.