Abstract
Surveillance programs in cirrhotic patients enable the detection of hepatocellular carcinoma (HCC) at early stages, when the tumor is amenable to curative treatments (60% of cases in Japan; 25 to 40% in Europe and the United States). Resection is the mainstay of treatment in noncirrhotic patients and in cirrhotics with well-preserved liver function. In modern series, a perioperative mortality ≤ 3% and 5-year survival rates above 50% are expected. Tumor recurrence complicates half of the cases at 3 years, but there is no unquestionable preventive treatment. Liver transplantation provides excellent outcomes applying the Milan criteria (single nodule ≤ 5 cm or two or three nodules ≤ 3 cm), with 5-year survival rates of 70% and low recurrence rates. Although expansion of selection criteria is appealing, it should be assessed in the setting of prospective well-designed studies. Intention-to-treat analysis has shown that wide extended indications lead to 25% 5-year survival rates. Living donor liver transplantation is having a minor impact in HCC management. Molecular markers are needed to better select the candidates for surgery.
Original language | English |
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Pages (from-to) | 181-200 |
Number of pages | 20 |
Journal | Seminars in Liver Disease |
Volume | 25 |
Issue number | 2 |
DOIs | |
Publication status | Published - May 2005 |
Keywords
- Adjuvant treatments
- Hepatocellular carcinoma
- Liver transplantation
- Living donor liver transplantation
- Resection
ASJC Scopus subject areas
- Hepatology