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Semin Liver Dis 2014; 34(04): 415-426
DOI: 10.1055/s-0034-1394365
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early Hepatocellular Carcinoma on the Procrustean Bed of Ablation, Resection, and Transplantation

Vincenzo Mazzaferro
1   Gastrointestinal Surgery and Liver Transplantation Units, National Cancer Institute INT, Milan, Italy
,
Riccardo Lencioni
2   Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Viareggio, Italy
,
Pietro Majno
3   Hepatobiliary Centre, Visceral Surgery and Transplantation Units, University Hospitals of Geneva, Geneva, Switzerland
› Author Affiliations
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Publication History

Publication Date:
04 November 2014 (online)

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Abstract

In the treatment of early hepatocellular carcinoma (HCC), resection ablation and transplantation have had excellent initial success. Choices have to be based on a broad and long-term vision integrating—besides patients' interests—the community's needs and resources. In this scenario, guidelines such as the Barcelona Clinic Liver Cancer (BCLC) staging system can be viewed as a hideous frame (symbolized by the myth of Procrustes, Poseidon's son who stretched or maimed travelers to fit into his bed), or as a useful structure against which personalized or innovative treatments must be reality checked. In this article, the latter view is taken: For resection, portal hypertension must still represent a powerful caveat, particularly because of poor long-term results. Expansion of the criteria may instead be explored for multiple tumors and vascular invasion, where good indications can consistently be selected in expert surgical centers. For ablation, competitive results can be obtained although a small, but appreciable proportion of patients with early vascular invasion (∼ 10%), as they could probably benefit from anatomical resections. Conversely, ablative techniques overcoming the location and size limitations are developing and may prove competitive. For transplantation, several equivalent careful expansions of Milan's Criteria can be accepted, but as more patients have access to the waiting list—often prioritized on non-HCC indications—current allocation models prove to be insufficient, if not plainly inequitable, and should be revised.

Keywords

hepatocellular carcinoma - liver resection - liver transplantation - radiofrequency ablation
 

  • References

  • 1 Intenational Agency for Research on Cancer Whorld Health Organization. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012 [Internet]. Available at: http://globocan.iarc.fr . Accessed September 9, 2014
    PubMedGoogle Scholar
  • 2 Olsen AH, Parkin DM, Sasieni P. Cancer mortality in the United Kingdom: projections to the year 2025. Br J Cancer 2008; 99 (9) 1549-1554
    CrossrefPubMedGoogle Scholar
  • 3 Davis GL, Alter MJ, El-Serag H, Poynard T, Jennings LW. Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology 2010; 138 (2) 513-521 , e1–e6
    CrossrefPubMedGoogle Scholar
  • 4 Fong ZV, Tanabe KK. The clinical management of hepatocellular carcinoma in the United States, Europe, and Asia: A comprehensive and evidence-based comparison and review. Cancer 2014; 120 (18) 2824-2838
    CrossrefPubMedGoogle Scholar
  • 5 Bruix J, Sherman M ; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (3) 1020-1022
    CrossrefPubMedGoogle Scholar
  • 6 European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56 (4) 908-943
    CrossrefPubMedGoogle Scholar
  • 7 Verslype C, Rosmorduc O, Rougier P ; ESMO Guidelines Working Group. Hepatocellular carcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23 (Suppl. 07) vii41-vii48
    CrossrefPubMedGoogle Scholar
  • 8 Torzilli G, Belghiti J, Kokudo N , et al. A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group. Ann Surg 2013; 257 (5) 929-937
    CrossrefPubMedGoogle Scholar
  • 9 Mazzaferro V, Roayaie S, Poon R, Majno PE. Dissecting EASL/AASLD Recommendations With a More Careful Knife: A Comment on “Surgical Misinterpretation” of the BCLC Staging System. Ann Surg 2013; ; [E-pub ahead of print]
    PubMedGoogle Scholar
  • 10 Bruix J, Fuster J. A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations? An observational study of the HCC East-West Study Group. Ann Surg 2013; ; [E-pub ahead of print]
    PubMedGoogle Scholar
  • 11 Arii S, Yamaoka Y, Futagawa S , et al; The Liver Cancer Study Group of Japan. Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. Hepatology 2000; 32 (6) 1224-1229
    CrossrefPubMedGoogle Scholar
  • 12 Livraghi T, Meloni F, Di Stasi M , et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?. Hepatology 2008; 47 (1) 82-89
    CrossrefPubMedGoogle Scholar
  • 13 Roayaie S, Obeidat K, Sposito C , et al. Resection of hepatocellular cancer ≤ 2 cm: results from two western centers. Hepatology 2013; 57 (4) 1426-1435
    CrossrefPubMedGoogle Scholar
  • 14 Majno PE, Mentha G, Mazzaferro V. Partial hepatectomy versus radiofrequency ablation for hepatocellular carcinoma: confirming the trial that will never be, and some comments on the indications for liver resection. Hepatology 2010; 51 (4) 1116-1118
    CrossrefPubMedGoogle Scholar
  • 15 Mazzaferro V, Majno P. Principles for the best multidisciplinary meetings. Lancet Oncol 2011; 12 (4) 323-325
    CrossrefPubMedGoogle Scholar
  • 16 Iranmanesh P, Vazquez O, Terraz S , et al. Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma. J Hepatol 2014; 60 (5) 969-974
    CrossrefPubMedGoogle Scholar
  • 17 Cucchetti A, Ercolani G, Vivarelli M , et al. Is portal hypertension a contraindication to hepatic resection?. Ann Surg 2009; 250 (6) 922-928
    CrossrefPubMedGoogle Scholar
  • 18 Boleslawski E, Petrovai G, Truant S , et al. Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis. Br J Surg 2012; 99 (6) 855-863
    CrossrefPubMedGoogle Scholar
  • 19 Bruix J, Castells A, Bosch J , et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 1996; 111 (4) 1018-1022
    CrossrefPubMedGoogle Scholar
  • 20 D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44 (1) 217-231
    CrossrefPubMedGoogle Scholar
  • 21 Cucchetti A, Piscaglia F, Cescon M , et al. An explorative data-analysis to support the choice between hepatic resection and radiofrequency ablation in the treatment of hepatocellular carcinoma. Dig Liver Dis 2014; 46 (3) 257-263
    CrossrefPubMedGoogle Scholar
  • 22 Kudo M, Izumi N, Kokudo N , et al; HCC Expert Panel of Japan Society of Hepatology. Management of hepatocellular carcinoma in Japan: consensus-based clinical practice guidelines proposed by the Japan Society of Hepatology (JSH) 2010 updated version. Dig Dis 2011; 29 (3) 339-364
    CrossrefPubMedGoogle Scholar
  • 23 Omata M, Lesmana LA, Tateishi R , et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010; 4 (2) 439-474
    CrossrefPubMedGoogle Scholar
  • 24 Le Treut YP, Hardwigsen J, Ananian P , et al. Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case-control series. J Gastrointest Surg 2006; 10 (6) 855-862
    CrossrefPubMedGoogle Scholar
  • 25 Azoulay D. Resection for hepatocellular carcinoma with hepatic vein tumour thrombus: pushing the limits beyond the guidelines frontiers. J Hepatol 2014; 61 (3) 462-463
    CrossrefPubMedGoogle Scholar
  • 26 Vilgrain V, Sibert A, Zappa M, Belghiti J. Sequential arterial and portal vein embolization in patients with cirrhosis and hepatocellular carcinoma: the hospital beaujon experience. Semin Intervent Radiol 2008; 25 (2) 155-161
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Bryant R, Laurent A, Tayar C, Cherqui D. Laparoscopic liver resection-understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 2009; 250 (1) 103-111
    CrossrefPubMedGoogle Scholar
  • 28 Soubrane O, Goumard C, Laurent A , et al. Laparoscopic resection of hepatocellular carcinoma: a French survey in 351 patients. HPB (Oxford) 2014; 16 (4) 357-365
    CrossrefPubMedGoogle Scholar
  • 29 Memeo R, de'Angelis N, Compagnon P , et al. Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study. World J Surg 2014;
    PubMedGoogle Scholar
  • 30 Tranchart H, Di Giuro G, Lainas P , et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 2010; 24 (5) 1170-1176
    CrossrefPubMedGoogle Scholar
  • 31 Lencioni R, Crocetti L. Local-regional treatment of hepatocellular carcinoma. Radiology 2012; 262 (1) 43-58
    CrossrefPubMedGoogle Scholar
  • 32 Erinjeri JP, Clark TWI. Cryoablation: mechanism of action and devices. J Vasc Interv Radiol 2010; 21 (8, Suppl) S187-S191
    CrossrefPubMedGoogle Scholar
  • 33 Lubner MG, Brace CL, Ziemlewicz TJ, Hinshaw JL, Lee Jr FT. Microwave ablation of hepatic malignancy. Semin Intervent Radiol 2013; 30 (1) 56-66
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Lu DSK, Kee ST, Lee EW. Irreversible electroporation: ready for prime time?. Tech Vasc Interv Radiol 2013; 16 (4) 277-286
    CrossrefPubMedGoogle Scholar
  • 35 Gervais DA, Goldberg SN, Brown DB, Soulen MC, Millward SF, Rajan DK. Society of Interventional Radiology position statement on percutaneous radiofrequency ablation for the treatment of liver tumors. J Vasc Interv Radiol 2009; 20 (, Suppl) S342-S347
    CrossrefPubMedGoogle Scholar
  • 36 Crocetti L, de Baere T, Lencioni R. Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Intervent Radiol 2010; 33 (1) 11-17
    CrossrefPubMedGoogle Scholar
  • 37 Lencioni RA, Allgaier HP, Cioni D , et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 2003; 228 (1) 235-240
    CrossrefPubMedGoogle Scholar
  • 38 Lin S-M, Lin C-J, Lin C-C, Hsu C-W, Chen Y-C. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology 2004; 127 (6) 1714-1723
    CrossrefPubMedGoogle Scholar
  • 39 Shiina S, Teratani T, Obi S , et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 2005; 129 (1) 122-130
    CrossrefPubMedGoogle Scholar
  • 40 Lin S-M, Lin C-J, Lin C-C, Hsu C-W, Chen Y-C. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 2005; 54 (8) 1151-1156
    CrossrefPubMedGoogle Scholar
  • 41 Brunello F, Veltri A, Carucci P , et al. Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: a randomized controlled trial. Scand J Gastroenterol 2008; 43 (6) 727-735
    CrossrefPubMedGoogle Scholar
  • 42 Lencioni R, Cioni D, Crocetti L , et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 2005; 234 (3) 961-967
    CrossrefPubMedGoogle Scholar
  • 43 Orlando A, Leandro G, Olivo M, Andriulli A, Cottone M. Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials. Am J Gastroenterol 2009; 104 (2) 514-524
    CrossrefPubMedGoogle Scholar
  • 44 Cho YK, Kim JK, Kim MY, Rhim H, Han JK. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology 2009; 49 (2) 453-459
    CrossrefPubMedGoogle Scholar
  • 45 Germani G, Pleguezuelo M, Gurusamy K, Meyer T, Isgrò G, Burroughs AK. Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocellular carcinoma: a meta-analysis. J Hepatol 2010; 52 (3) 380-388
    CrossrefPubMedGoogle Scholar
  • 46 Bouza C, López-Cuadrado T, Alcázar R, Saz-Parkinson Z, Amate JM. Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol 2009; 9: 31
    CrossrefPubMedGoogle Scholar
  • 47 Tateishi R, Shiina S, Teratani T , et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer 2005; 103 (6) 1201-1209
    CrossrefPubMedGoogle Scholar
  • 48 Choi D, Lim HK, Rhim H , et al. Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol 2007; 17 (3) 684-692
    CrossrefPubMedGoogle Scholar
  • 49 N'Kontchou G, Mahamoudi A, Aout M , et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis. Hepatology 2009; 50 (5) 1475-1483
    CrossrefPubMedGoogle Scholar
  • 50 Lu DSK, Yu NC, Raman SS , et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology 2005; 234 (3) 954-960
    CrossrefPubMedGoogle Scholar
  • 51 Rossi S, Garbagnati F, Lencioni R , et al. Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply. Radiology 2000; 217 (1) 119-126
    CrossrefPubMedGoogle Scholar
  • 52 Veltri A, Moretto P, Doriguzzi A, Pagano E, Carrara G, Gandini G. Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol 2006; 16 (3) 661-669
    CrossrefPubMedGoogle Scholar
  • 53 Helmberger T, Dogan S, Straub G , et al. Liver resection or combined chemoembolization and radiofrequency ablation improve survival in patients with hepatocellular carcinoma. Digestion 2007; 75 (2-3) 104-112
    CrossrefPubMedGoogle Scholar
  • 54 Yamasaki T, Kurokawa F, Shirahashi H, Kusano N, Hironaka K, Okita K. Percutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow. Comparison with standard percutaneous radiofrequency ablation therapy. Cancer 2002; 95 (11) 2353-2360
    CrossrefPubMedGoogle Scholar
  • 55 Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K. Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment?. Radiology 2009; 252 (3) 905-913
    CrossrefPubMedGoogle Scholar
  • 56 Morimoto M, Numata K, Kondou M, Nozaki A, Morita S, Tanaka K. Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization. Cancer 2010; 116 (23) 5452-5460
    CrossrefPubMedGoogle Scholar
  • 57 Kim JH, Won HJ, Shin YM , et al. Medium-sized (3.1-5.0 cm) hepatocellular carcinoma: transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone. Ann Surg Oncol 2011; 18 (6) 1624-1629
    CrossrefPubMedGoogle Scholar
  • 58 Takaki H, Yamakado K, Sakurai H , et al. Radiofrequency ablation combined with chemoembolization: treatment of recurrent hepatocellular carcinomas after hepatectomy. AJR Am J Roentgenol 2011; 197 (2) 488-494
    CrossrefPubMedGoogle Scholar
  • 59 Peng Z-W, Zhang Y-J, Chen M-S , et al. Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol 2013; 31 (4) 426-432
    CrossrefPubMedGoogle Scholar
  • 60 Lencioni R, Crocetti L, Petruzzi P , et al. Doxorubicin-eluting bead-enhanced radiofrequency ablation of hepatocellular carcinoma: a pilot clinical study. J Hepatol 2008; 49 (2) 217-222
    CrossrefPubMedGoogle Scholar
  • 61 Boutros C, Somasundar P, Garrean S, Saied A, Espat NJ. Microwave coagulation therapy for hepatic tumors: review of the literature and critical analysis. Surg Oncol 2010; 19 (1) e22-e32
    CrossrefPubMedGoogle Scholar
  • 62 Groeschl RT, Pilgrim CHC, Hanna EM , et al. Microwave ablation for hepatic malignancies: a multiinstitutional analysis. Ann Surg 2014; 259 (6) 1195-1200
    CrossrefPubMedGoogle Scholar
  • 63 Martin RCG, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol 2010; 17 (1) 171-178
    CrossrefPubMedGoogle Scholar
  • 64 Cannon R, Ellis S, Hayes D, Narayanan G, Martin II RCG. Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol 2013; 107 (5) 544-549
    CrossrefPubMedGoogle Scholar
  • 65 Silk MT, Wimmer T, Lee KS , et al. Percutaneous ablation of peribiliary tumors with irreversible electroporation. J Vasc Interv Radiol 2014; 25 (1) 112-118
    CrossrefPubMedGoogle Scholar
  • 66 Scheffer HJ, Nielsen K, de Jong MC , et al. Irreversible electroporation for nonthermal tumor ablation in the clinical setting: a systematic review of safety and efficacy. J Vasc Interv Radiol 2014; 25 (7) 997-1011 , quiz 1011
    CrossrefPubMedGoogle Scholar
  • 67 Dunne RM, Shyn PB, Sung JC , et al. Percutaneous treatment of hepatocellular carcinoma in patients with cirrhosis: a comparison of the safety of cryoablation and radiofrequency ablation. Eur J Radiol 2014; 83 (4) 632-638
    CrossrefPubMedGoogle Scholar
  • 68 Mazzaferro V, Regalia E, Doci R , et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334 (11) 693-699
    CrossrefPubMedGoogle Scholar
  • 69 Yao FY, Ferrell L, Bass NM , et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33 (6) 1394-1403
    CrossrefPubMedGoogle Scholar
  • 70 Mazzaferro V, Llovet JM, Miceli R , et al; Metroticket Investigator Study Group. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 2009; 10 (1) 35-43
    CrossrefPubMedGoogle Scholar
  • 71 Toso C, Asthana S, Bigam DL, Shapiro AMJ, Kneteman NM. Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of Transplant Recipients database. Hepatology 2009; 49 (3) 832-838
    CrossrefPubMedGoogle Scholar
  • 72 Toso C, Dupuis-Lozeron E, Majno P , et al. A model for dropout assessment of candidates with or without hepatocellular carcinoma on a common liver transplant waiting list. Hepatology 2012; 56 (1) 149-156
    CrossrefPubMedGoogle Scholar
  • 73 Navasa M, Bruix J. Multifaceted perspective of the waiting list for liver transplantation: the value of pharmacokinetic models. Hepatology 2010; 51 (1) 12-15
    CrossrefPubMedGoogle Scholar
  • 74 Mehta N, Dodge JL, Goel A, Roberts JP, Hirose R, Yao FY. Identification of liver transplant candidates with hepatocellular carcinoma and a very low dropout risk: implications for the current organ allocation policy. Liver Transpl 2013; 19 (12) 1343-1353
    CrossrefPubMedGoogle Scholar
  • 75 Vibert E, Azoulay D, Hoti E , et al. Progression of alphafetoprotein before liver transplantation for hepatocellular carcinoma in cirrhotic patients: a critical factor. Am J Transplant 2010; 10 (1) 129-137
    CrossrefPubMedGoogle Scholar
  • 76 Duvoux C, Roudot-Thoraval F, Decaens T , et al; Liver Transplantation French Study Group. Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan Criteria. Gastroenterology 2012; 143 (4) 986-994 , e3, quiz e14–e15
    CrossrefPubMedGoogle Scholar
  • 77 Francoz C, Belghiti J, Castaing D , et al. Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system. Liver Transpl 2011; 17 (10) 1137-1151
    CrossrefPubMedGoogle Scholar
  • 78 Otto G, Herber S, Heise M , et al. Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma. Liver Transpl 2006; 12 (8) 1260-1267
    CrossrefPubMedGoogle Scholar
  • 79 Roberts JP, Venook A, Kerlan Jr R, Yao F. Hepatocellular carcinoma: ablate and wait versus rapid transplantation. Liver Transpl 2010; 16 (8) 925-929
    CrossrefPubMedGoogle Scholar
  • 80 Ravaioli M, Grazi GL, Dazzi A , et al. Survival benefit after liver transplantation: a single European center experience. Transplantation 2009; 88 (6) 826-834
    CrossrefPubMedGoogle Scholar
  • 81 Vitale A, Volk M, Cillo U. Transplant benefit for patients with hepatocellular carcinoma. World J Gastroenterol 2013; 19 (48) 9183-9188
    CrossrefPubMedGoogle Scholar
  • 82 Todo S, Furukawa H ; Japanese Study Group on Organ Transplantation. Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in Japan. Ann Surg 2004; 240 (3) 451-459 , discussion 459–461
    CrossrefPubMedGoogle Scholar
  • 83 Mazzaferro V, Battiston C, Perrone S , et al. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg 2004; 240 (5) 900-909
    CrossrefPubMedGoogle Scholar
  • 84 Fontana RJ, Hamidullah H, Nghiem H , et al. Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: a safe and effective bridge to liver transplantation. Liver Transpl 2002; 8 (12) 1165-1174
    CrossrefPubMedGoogle Scholar
  • 85 Bharat A, Brown DB, Crippin JS , et al. Pre-liver transplantation locoregional adjuvant therapy for hepatocellular carcinoma as a strategy to improve longterm survival. J Am Coll Surg 2006; 203 (4) 411-420
    CrossrefPubMedGoogle Scholar
  • 86 Yao FY, Kinkhabwala M, LaBerge JM , et al. The impact of pre-operative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma. Am J Transplant 2005; 5 (4 Pt 1) 795-804
    CrossrefPubMedGoogle Scholar
  • 87 Berzigotti A, Reig M, Abraldes JG, Bosch J, Bruix J. Portal hypertension on the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology 2014; [Epub ahead of print]
    PubMedGoogle Scholar
  • 88 Sala M, Fuster J, Llovet JM , et al; Barcelona Clinic Liver Cancer (BCLC) Group. High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation. Liver Transpl 2004; 10 (10) 1294-1300
    CrossrefPubMedGoogle Scholar
  • 89 Fuks D, Dokmak S, Paradis V, Diouf M, Durand F, Belghiti J. Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology 2012; 55 (1) 132-140
    CrossrefPubMedGoogle Scholar
  • 90 Cherqui D, Laurent A, Mocellin N , et al. Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation. Ann Surg 2009; 250 (5) 738-746
    CrossrefPubMedGoogle Scholar
  • 91 Landman MP, Feurer ID, Pinson CW, Moore DE. Which is more cost-effective under the MELD system: primary liver transplantation, or salvage transplantation after hepatic resection or after loco-regional therapy for hepatocellular carcinoma within Milan criteria?. HPB (Oxford) 2011; 13 (11) 783-791
    CrossrefPubMedGoogle Scholar
  • 92 Toso C, Merani S, Bigam DL, Shapiro AMJ, Kneteman NM. Sirolimus-based immunosuppression is associated with increased survival after liver transplantation for hepatocellular carcinoma. Hepatology 2010; 51 (4) 1237-1243
    CrossrefPubMedGoogle Scholar
  • 93 Sposito C, Mariani L, Germini A , et al. Comparative efficacy of sorafenib versus best supportive care in recurrent hepatocellular carcinoma after liver transplantation: a case-control study. J Hepatol 2013; 59 (1) 59-66
    CrossrefPubMedGoogle Scholar