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Management of Early Hepatocellular Carcinoma in Patients with Well-Compensated Cirrhosis

  • Hepatobiliary and Pancreatic Tumors
  • Published:
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Abstract

Hepatocellular carcinoma (HCC) usually affects patients with chronic liver disease. While resection is the primary treatment of HCC in patients without cirrhosis, in the setting of moderate to severe cirrhosis, liver transplantation is the preferred therapy, as it simultaneously treats the tumor and the underlying liver condition. The optimal management of patients with HCC and early cirrhosis remains controversial. Although liver transplantation for HCC within the Milan criteria has been shown to have excellent long-term survival rates and low recurrence rates, its application is limited by organ availability. Due to the shortage of donors, a portion of patients drop out from the waiting list due to tumor progression. One alternative to transplantation is hepatic resection. In addition to the reported 50% 5-year survival rates, resection allows a better understanding of tumor biology through pathologic examination of the specimen, which may guide decision-making regarding salvage liver transplantation. Other nonsurgical locoregional therapies, such as transarterial chemoembolization and radiofrequency ablation, also serve as primary therapies and as a bridge to transplantation. The management of patients with early HCC is complex and multidimensional. The care of these patients is best served by a multidisciplinary approach, with consideration of the feasibility of transplantation weighed against the aggressiveness of the tumor biology and underlying hepatic dysfunction. All modalities of therapy should be viewed as complementary, not exclusive, therapeutic strategies.

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Acknowledgement

Dr. Pawlik is supported by Grant Number 1KL2RR025006-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

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Authors and Affiliations

  1. Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA

    Steven C. Cunningham MD & Timothy M. Pawlik MD, MPH

  2. Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Susan Tsai MD & Timothy M. Pawlik MD, MPH

  3. Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD, Paulo Mira MD & Eduardo Barroso MD

  4. Department of Surgery, Division of Transplantation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Andrew Cameron PhD

  5. Department of Surgery, Division of Transplantation, University of Maryland Medical Center, Baltimore, MD, USA

    Benjamin Philosophe MD

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  1. Steven C. Cunningham MD
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  2. Susan Tsai MD
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  3. Hugo P. Marques MD
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  4. Paulo Mira MD
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  8. Timothy M. Pawlik MD, MPH
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Correspondence to Timothy M. Pawlik MD, MPH.

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Steven C. Cunningham and Susan Tsai contributed equally to the preparation of this manuscript.

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Cunningham, S.C., Tsai, S., Marques, H.P. et al. Management of Early Hepatocellular Carcinoma in Patients with Well-Compensated Cirrhosis. Ann Surg Oncol 16, 1820–1831 (2009). https://doi.org/10.1245/s10434-009-0364-1

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  • DOI: https://doi.org/10.1245/s10434-009-0364-1

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