Liver Transplantation for Recurrent Hepatocellular Carcinoma on Cirrhosis After Liver Resection: University of Bologna Experience

Liver resection (LR) for patients with small hepatocellular carcinoma (HCC) with preserved liver function, employing liver transplantation (LT) as a salvage procedure (SLT) in the event of HCC recurrence, is a debated strategy. From 1996 to 2005, we treated 227 cirrhotic patients with HCC transplantable: 80 LRs and 147 LTs of 293 listed for transplantation. Among 80 patients eligible for transplantation who underwent LR, 39 (49%) developed HCC recurrence and 12/39 (31%) of these patients presented HCC recurrence outside Milan criteria. Only 10 of the 39 patients underwent LT, a transplantation rate of 26% of patients with HCC recurrence. According to intention‐to‐treat analysis of transplantable HCC patients who underwent LR (n = 80), compared to all those listed for transplantation (n = 293), 5‐year overall survival was 66% in the LR group versus 58% in patients listed for LT, respectively (p = NS); 5‐year disease‐free survival was 41% in the LR group versus 54% in patients listed for LT (p = NS). Comparable 5‐year overall (62% vs. 73%, p = NS) and disease‐free (48% vs. 71%, p = NS) survival rates were obtained for SLT and primary LT for HCC, respectively. LR is a valid treatment for small HCC and in the event of recurrence, SLT is a safe and effective procedure. By intention to treat analysis of survival of transplantable HCC patients who underwent liver resection (LR) compared to those listed for transplantation, this study shows that LR for patients with small HCC with preserved liver function, employing LT as a salvage procedure (SLT) in the event of HCC recurrence, is a safe and effective strategy. See also editorial by Botha in this issue on page 1085.