Abstract
Background
There is no consensus regarding the optimal surgical treatment for transplantable hepatocellular carcinoma (HCC) patients with well-compensated cirrhosis. Our aim was to compare outcomes between Child-Pugh A (CPA) cirrhotics who underwent liver resection or transplantation for HCC.
Methods
Clinicopathologic data were retrospectively collected for all surgically treated HCC patients between 7/1992 and 12/2015. Disease-free survival (DFS) and overall survival (OS) were calculated from the time of operation or diagnosis (intention-to-treat analysis including patients removed from the transplant list). The average overall cost including pre-operative and post-operative procedures was calculated for each group.
Results
Of the 513 surgically treated HCC patients, 184 had CPA cirrhosis and fulfilled the Milan criteria (MC). Of those, 95 (52%) were resected and 89 (48%) were transplanted. Twenty-two patients were removed from the transplant list. Transplanted patients were younger (p < 0.001), had a higher MELD score (p < 0.001) and a higher frequency of hepatitis C (p < 0.001). Length of stay and postoperative complication rates were similar between groups. DFS was longer for transplanted patients (3-, 5-, and 10-year DFS rates 48, 44, 31% vs 96, 94, 94%, respectively, p < 0.001). OS was similar between groups (3-, 5-, and 10-year OS rates 76, 62, 41% vs 82, 77, 53%, respectively, p = 0.07). Only size of greatest lesion and T stage were independent predictors of OS. The cost was much higher for the transplant group, even when accounting for the treatment of recurrences ($37,391 vs $137,996).
Conclusions
Since OS is similar between CPA cirrhotics within the MC undergoing resection or transplantation for HCC, but cost is significantly higher for transplantation. Resection should be considered for first-line treatment.
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All authors approved the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. T.M. was involved in the conception and design of the study; the acquisition, analysis, and interpretation of data; and drafted the manuscript. D.X. participated in the design of the study; acquisition, analysis, and interpretation of the data; and drafted and revised the manuscript. M.Q. was involved in the conception and design of the study; the acquisition, analysis, and interpretation of data; and revised the manuscript critically for important intellectual content. R.P.-V. was involved in the conception and design of the study; the acquisition, analysis, and interpretation of data; and revised the manuscript critically for important intellectual content. L.C. was involved in the conception and design of the study; the acquisition, analysis, and interpretation of data; and drafted the manuscript. M.S.P. participated in the design of the study, analysis and interpretation of the data, and revised the manuscript critically for important intellectual content. J.T.A. participated in the design of the study, analysis and interpretation of the data, and revised the manuscript critically for important intellectual content. F.F. participated in the design of the study, analysis and interpretation of the data, and revised the manuscript critically for important intellectual content. U.B. participated in the design of the study, analysis and interpretation of the data, and revised the manuscript critically for important intellectual content. P.A.V. was involved in the design of the study, the acquisition and interpretation of data, and revised the manuscript critically for important intellectual content. N.E. was involved in the conception and design of the study, the acquisition and interpretation of data, and drafted and revised the manuscript. K.K.T. participated in the design of the study, analysis and interpretation of the data, and revised the manuscript critically for important intellectual content. D.B. was involved in the design of the study, the acquisition and interpretation of data, and revised the manuscript critically for important intellectual content. H.Y. was involved in the conception and design of the study; the acquisition, analysis, and interpretation of data; and drafted the manuscript. J.F.M. was involved in the conception and design of the study; the acquisition, analysis, and interpretation of data; and revised the manuscript critically for important intellectual content. D.C.C. was involved in the conception and design of the study; the acquisition, analysis, and interpretation of data; and drafted the manuscript. C.R.F. was involved in the conception and design of the study; the acquisition, analysis, and interpretation of data; and drafted and revised the manuscript critically for important intellectual content.
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Michelakos, T., Xourafas, D., Qadan, M. et al. Hepatocellular Carcinoma in Transplantable Child-Pugh A Cirrhotics: Should Cost Affect Resection vs Transplantation?. J Gastrointest Surg 23, 1135–1142 (2019). https://doi.org/10.1007/s11605-018-3946-z
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DOI: https://doi.org/10.1007/s11605-018-3946-z