Survival rates after liver transplantation were superior to liver resection for patients with hepatocellular carcinoma, according to results of a recently published systematic review and meta-analysis. However, overall morbidity and mortality rates and survival rate among patients with early HCC were similar.
“In practical terms, patients for whom liver resection is an option should undergo the procedure and then be evaluated for transplant in the event of a recurrence,” Markus B. Schoenberg, MD, from the University Hospital of Munich, and colleagues wrote. “However, in order for all patients to receive the appropriate treatment in line with their disease stage, each individual case must be discussed and re-evaluated on a multidisciplinary basis. This could eventually make it possible for donor livers to be used for the greatest possible benefit to all patients.”
The researchers selected 54 studies from a review of the Medline, PubMed and EMBASE databases. Of 13,794 patients in the studies, 7,990 underwent liver resection and 5,804 underwent liver transplantation.
A meta-analysis revealed that liver transplant (65.3%) had significantly better outcomes than resection (67.4%; OR = 0.82; 95% CI, 0.68-0.99). At 5 years, liver transplant (61.26%) remained superior to resection (51.9%; OR = 0.62; 95% CI, 0.5-0.76).
The eight studies that reported early HCC showed that survival rates were not significantly different between liver transplant and resection. At 5 years, however, liver transplant (66.67%) was superior to resection (60.35%; OR = 0.6; 95% CI, 0.45-0.78).
After a review of all included studies, liver resection resulted in fewer complication (25.79% vs. 33.15%) and lower postoperative mortality rates (4.08% vs. 7.69%) compared with liver transplant. The rate of complications and mortality were similar, however, after a subgroup analysis.
“There is a need for innovative, effective treatment allocation strategies, particularly in view of the shortage of donor livers,” the researchers wrote. While transplantation offers a better chance at 5-year survival, liver resection is an option for patients with sufficient liver function. “In these cases, resection would be at least an effective strategy for bridging to transplant, because ... these patients have excellent short-term outcomes (1-year follow-up), at any rate comparable to those for liver transplant.” – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.