Prospective Study Comparing Resection Versus Living Donor Liver Transplantation In Management Of Early Hepatocellular Cacinoma

Hatem Sayed Saber


Abstract


Hepatic resection and transplantation remain the cornerstone therapies for patients with HCC as they are the curative treatments. However these treatments are not suitable for the majority of patients but can achieve the best outcome in carefully selected patients with early tumours or very early tumours. In patients with early tumors and advanced liver disease, transplantation is clearly the treatment of choice with 5-year survival rates of roughly 70% as it cures the underlying chronic liver disease which induces tumourigenesis in the first place. LT, however, is limited by organ shortage and the inherent risk of transplantation and immunosuppression. This fact, along with the improved outcomes of LR amongst those with chronic liver disease, has led to an increased interest in LR for HCC. However, Sometimes LR and LT are complimentary, particularly when LR is considered as a bridge to transplantation. The essential challenge is determining which therapeutic modality is best for patients with relatively early-stage tumors (resection versus transplantation). Numerous factors must be considered including tumor size, multifocality, medical comorbidity, and geographic factors that affect waitlist time and organ availability. The crucial element limiting the general applicability of LDLT is the risk of harming a healthy living donor. In the literature, the overall mortality attributed to living donor procedures is lower than 0.5%, but the risk of morbidity is slightly significant. Finally, the question arises if LR is still justified in the treatment of HCC? More than Ten years ago, the normal approach was to resect HCC and only when it was not feasible, LT was to be considered. Because it has been shown that for patients with liver cirrhosis and small, uninodular, or binodular tumors, LT was the best option, whereas for patients with non-severe cirrhosis (Child A), LR was indicated. However, recent studies indicate that even for patients with Child A cirrhosis, LT is a better option with particularly significant longer disease-free survival. Unfortunately, this strategy is limited by the shortage of donor organs. Should resection be abandoned completely in the treatment of HCC? It is certain that some cases of small HCC will be localized and will remain so. These patients may be cured by hepatic resection. Efforts must, therefore, be made to identify these cases, especially in Western countries, so that resection is not withheld from suitable cases and transplantation is not performed unnecessarily. Resection still is probably indicated for large tumors in non-cirrohtic or well-compensated cirrhotic livers if there is


Other data

Other Titles دراسة مستقبلية للمقارنة بين استئصال جزء من الكبد و زراعة الكبد من متبرع حى في علاج حالات السرطان الأولى للخلايا الكبدية
Issue Date 2016
URI http://research.asu.edu.eg/handle/12345678/2732


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