Abstracts
1997 Digestive Disease Week

Surgical management of hepatocellular carcinoma.

B Philosophe, B Langer, A Hemming, P Greig, M Cattral, I Wanless, I Rasul, N Baxter, B Taylor. Department of Surgery, University of Toronto, The Toronto Hospital, Toronto, Ontario, Canada.

The relative scarcity of donor organs available for transplantation led us to assess whether liver transplantation remains acceptable management for HCC. 115 patients with HCC were managed surgically at our institution between 1985 and 1995. 65 patients had resections (R) and 50 had liver transplantation(LT). All patients with technically resectable lesions underwent resection while patients with unresectable tumors confined to the liver underwent LT. No adjuvant chemotherapy was used There was no difference in hepatitis B status between R and LT groups 54% vs 38% p =0.08)however there were more cirrhotics in the LT than in the R group.( 84% vs 51% p= 0.005) Operative mortality was 3.1% and 10% for R and LT respectively.. Five year overall Kaplan Meier survival for R and LT were 42%and 41% respectively , however LT gave better 5 year actuarial tumor recurrence rates than R (18% vs 45% p=0.001). Patients transplanted with HBV had significantly worse overall 5 year Kaplan Meier survival than non-HBV patients( 24% vs 68% p = 0.006) with most deaths secondary to recurrent HBV. Only 2 of 19 HBV +ve patients transplanted for HCC remain alive and both have recurrent HBV .On univariate analysis vascular invasion by tumor, tumor size and multiple tumors were significant negative predictors of outcome, however only multiple tumors remained a negative predictor on multivariate analysis( p = 0.009). None of 11 patients that underwent resection for multiple tumors survived 2 years while 5 year Kaplan Meier survival for the 24 patients with multiple tumors that had LT was 46.

Conclusions: LT is an effective method of treating HCC especially when HBV +ve patients are excluded. The scarcity of organs presently available for transplantation precludes the expansion of transplantation to patients with resectable lesions although transplantation may well offer a survival benefit to these patients especially in patients with multiple tumors. HBV+ patients should receive LT only in the setting of a clinical trial.