IntroductionThe incidence of hepatocellular carcinoma (HCC) in the United States has increased 75percnt; in the last decade. Liver transplantation is gaining acceptance for the treatment of early HCC, even in patients with adequate liver function. The objective of this study was to determine the long-term outcome of patients with early HCC who would have been candidates for transplantation but were treated instead with partial hepatectomy.MethodsFrom August 1989 to November 2001, 611 patients with HCC were evaluated at our institution and entered into a prospective database. There were 180 (29percnt;) patients who underwent partial hepatectomy, of whom 36 (20percnt;) satisfied the currently accepted criteria for transplantationcolon; 2 or 3 lesions each le; 3 cm in size or a solitary tumor le; 5 cm. Survival was determined by Kaplan-Meier analysis.ResultsMedian tumor size was 3.5 (range, 1.8ndash;5) cm and the median number of lesions was 1 (range, 1ndash;3). Patients had pathologically confirmed cirrhosis of the liver in 78percnt; (28/36) of cases, and 86percnt; had normal liver function (Child class A). Perioperative morbidity was 25percnt;, the median length of hospital stay was 8 (range, 4ndash;24) days, and there was 1 (2.8percnt;) perioperative death. At a median follow-up of 35 months for survivors, the 1-, 3-, and 5-year overall survival was 85percnt;, 74percnt;, and 69percnt;, respectively, with a median survival of 71 months. The 5-year disease-free survival was 48percnt; with a median of 52 months.ConclusionsPartial hepatectomy in patients with early HCC who are otherwise eligible for transplantation can be performed with minimal morbidity and can achieve comparable 5-year survival to that reported for liver transplantation. Resection should be considered the standard therapy for patients with HCC who have adequate liver reserve.
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