Surgery for Hepatocellular Carcinoma in Patients with Child–Pugh B Cirrhosis: Hepatic Resection Versus Living Donor Liver Transplantation

Norifumi Harimoto, Tomoharu Yoshizumi, Yukiko Fujimoto, Takashi Motomura, Youhei Mano, Takeo Toshima, Shinji Itoh, Noboru Harada, Toru Ikegami, Hideaki Uchiyama, Yuji Soejima, Yoshihiko Maehara

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Liver transplantation has been established as the optimal treatment for hepatocellular carcinoma in cirrhotic patients, but hepatic resection is also effective in patients with well-preserved liver function. Determining the suitable surgical treatment for patients with Child–Pugh class B cirrhosis is a more difficult challenge. Methods: We retrospectively compared the results of hepatic resection and living donor liver transplantation for hepatocellular carcinoma in 137 patients with Child–Pugh class B cirrhosis. The procedures were performed at Kyushu University Hospital from April 2014 through October 2016. Results: Patients who underwent hepatic resection were significantly older and had better liver function, larger tumor size, smaller number of tumors, and less surgical stress compared with patients who underwent living donor liver transplantation. The overall survival rate and the recurrence-free survival rate in patients with transplantation were significantly better than that in patients with resection. The multivariate analysis showed that recurrent hepatocellular carcinoma and microvascular invasion were significant prognostic factors for both overall and recurrence-free survival in the hepatic resection group. In the group with protein induced by vitamin K absence or antagonist-II ≥300 mAU/mL, both the overall survival curve and the recurrence-free survival curve in patients with living donor liver transplantation were not significantly different from those in patients with hepatic resection. Conclusions: Living donor liver transplantation for hepatocellular carcinoma in patients with Child–Pugh class B cirrhosis was favorable under the condition of protein induced by vitamin K absence or antagonist-II <300 mAU/mL in selected recipients and donors. Hepatic resection for recurrent hepatocellular carcinoma and excessive blood loss should be avoided in patients with Child–Pugh class B cirrhosis.

Original languageEnglish
Pages (from-to)2606-2616
Number of pages11
JournalWorld journal of surgery
Volume42
Issue number8
DOIs
Publication statusPublished - Aug 1 2018

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Living Donors
Liver Cirrhosis
Liver Transplantation
Hepatocellular Carcinoma
Liver
Fibrosis
Recurrence
Survival
Survival Rate
Neoplasms
Multivariate Analysis
Transplantation
Tissue Donors

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Surgery for Hepatocellular Carcinoma in Patients with Child–Pugh B Cirrhosis : Hepatic Resection Versus Living Donor Liver Transplantation. / Harimoto, Norifumi; Yoshizumi, Tomoharu; Fujimoto, Yukiko; Motomura, Takashi; Mano, Youhei; Toshima, Takeo; Itoh, Shinji; Harada, Noboru; Ikegami, Toru; Uchiyama, Hideaki; Soejima, Yuji; Maehara, Yoshihiko.

In: World journal of surgery, Vol. 42, No. 8, 01.08.2018, p. 2606-2616.

Research output: Contribution to journalArticle

Harimoto, Norifumi ; Yoshizumi, Tomoharu ; Fujimoto, Yukiko ; Motomura, Takashi ; Mano, Youhei ; Toshima, Takeo ; Itoh, Shinji ; Harada, Noboru ; Ikegami, Toru ; Uchiyama, Hideaki ; Soejima, Yuji ; Maehara, Yoshihiko. / Surgery for Hepatocellular Carcinoma in Patients with Child–Pugh B Cirrhosis : Hepatic Resection Versus Living Donor Liver Transplantation. In: World journal of surgery. 2018 ; Vol. 42, No. 8. pp. 2606-2616.
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AU - Yoshizumi, Tomoharu

AU - Fujimoto, Yukiko

AU - Motomura, Takashi

AU - Mano, Youhei

AU - Toshima, Takeo

AU - Itoh, Shinji

AU - Harada, Noboru

AU - Ikegami, Toru

AU - Uchiyama, Hideaki

AU - Soejima, Yuji

AU - Maehara, Yoshihiko

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N2 - Background: Liver transplantation has been established as the optimal treatment for hepatocellular carcinoma in cirrhotic patients, but hepatic resection is also effective in patients with well-preserved liver function. Determining the suitable surgical treatment for patients with Child–Pugh class B cirrhosis is a more difficult challenge. Methods: We retrospectively compared the results of hepatic resection and living donor liver transplantation for hepatocellular carcinoma in 137 patients with Child–Pugh class B cirrhosis. The procedures were performed at Kyushu University Hospital from April 2014 through October 2016. Results: Patients who underwent hepatic resection were significantly older and had better liver function, larger tumor size, smaller number of tumors, and less surgical stress compared with patients who underwent living donor liver transplantation. The overall survival rate and the recurrence-free survival rate in patients with transplantation were significantly better than that in patients with resection. The multivariate analysis showed that recurrent hepatocellular carcinoma and microvascular invasion were significant prognostic factors for both overall and recurrence-free survival in the hepatic resection group. In the group with protein induced by vitamin K absence or antagonist-II ≥300 mAU/mL, both the overall survival curve and the recurrence-free survival curve in patients with living donor liver transplantation were not significantly different from those in patients with hepatic resection. Conclusions: Living donor liver transplantation for hepatocellular carcinoma in patients with Child–Pugh class B cirrhosis was favorable under the condition of protein induced by vitamin K absence or antagonist-II <300 mAU/mL in selected recipients and donors. Hepatic resection for recurrent hepatocellular carcinoma and excessive blood loss should be avoided in patients with Child–Pugh class B cirrhosis.

AB - Background: Liver transplantation has been established as the optimal treatment for hepatocellular carcinoma in cirrhotic patients, but hepatic resection is also effective in patients with well-preserved liver function. Determining the suitable surgical treatment for patients with Child–Pugh class B cirrhosis is a more difficult challenge. Methods: We retrospectively compared the results of hepatic resection and living donor liver transplantation for hepatocellular carcinoma in 137 patients with Child–Pugh class B cirrhosis. The procedures were performed at Kyushu University Hospital from April 2014 through October 2016. Results: Patients who underwent hepatic resection were significantly older and had better liver function, larger tumor size, smaller number of tumors, and less surgical stress compared with patients who underwent living donor liver transplantation. The overall survival rate and the recurrence-free survival rate in patients with transplantation were significantly better than that in patients with resection. The multivariate analysis showed that recurrent hepatocellular carcinoma and microvascular invasion were significant prognostic factors for both overall and recurrence-free survival in the hepatic resection group. In the group with protein induced by vitamin K absence or antagonist-II ≥300 mAU/mL, both the overall survival curve and the recurrence-free survival curve in patients with living donor liver transplantation were not significantly different from those in patients with hepatic resection. Conclusions: Living donor liver transplantation for hepatocellular carcinoma in patients with Child–Pugh class B cirrhosis was favorable under the condition of protein induced by vitamin K absence or antagonist-II <300 mAU/mL in selected recipients and donors. Hepatic resection for recurrent hepatocellular carcinoma and excessive blood loss should be avoided in patients with Child–Pugh class B cirrhosis.

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