Letters To The Editor Open Access
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World J Gastroenterol. Nov 14, 2009; 15(42): 5371-5371
Published online Nov 14, 2009. doi: 10.3748/wjg.15.5371
Hepatocellular carcinoma and evidence-based surgery
Alain Braillon, Hepatology and Public Health, University Hospital, 80000 Amiens, France
Author contributions: Braillon A wrote this paper.
Correspondence to: Alain Braillon, MD, PhD, Hepatology and Public Health, University Hospital, 80000 Amiens, France. braillon.alain@chu-amiens.fr
Telephone: +33-3-22667937 Fax: +33-3-22668198
Received: July 23, 2009
Revised: August 13, 2009
Accepted: August 20, 2009
Published online: November 14, 2009

Abstract

Transplantation cannot be considered the most important therapeutic procedure for hepatocellular carcinoma (HCC). In France, no more than 2% of patients with HCC undergo a transplantation. Randomized controlled trial must assess the benefit to risk ratio of various potentially “curative” treatment procedures (transplantation, resection, radio-frequency ablation).

Key Words: Hepatocellular carcinoma; Evidence based medicine



TO THE EDITOR

Rampone et al[1] stated that hepatocellular carcinoma (HCC) still remains a considerable challenge for surgeons and that transplantation is the most important therapeutic procedure. However, facts seem different for an evidence-based medicine adept[2].

There is a challenge for the patient because yet no randomized controlled trial (RCT) has assessed the benefit to risk ratio of various potentially “curative” treatment procedures (transplantation, resection, radio-frequency ablation). RCT is feasible. Benefit of chemoembolization to patients with unresectable HCC and sorafenib in a palliative indication are evidence-based from RCT. Recruiting is not an issue since HCC is the fifth most common cause of cancer.

Transplantation cannot be considered the most important therapeutic approach. In France with 66 000 000 inhabitants, 7500 inhabitants die of HCC per year. In 2007, 1061 transplantations were performed for various conditions and 6% of the candidates died while on waiting list due to the shortage of organs[3]. In Europe, 15% of transplantations are performed for HCC[4]. Therefore, in France, no more than 2% of patients with HCC undergo a transplantation. Nevertheless, more than one out of four exceeds the Milan criteria, a situation which does not improve the results[4]. Again, data are missing, and the national agency in charge of transplantation does not publish survival after transplantation according to indications. However, they exist.

Footnotes

Peer reviewer: Salvatore Gruttadauria, MD, Assistant Professor, Abdominal Transplant Surgery, ISMETT, Via E. Tricomi, 190127 Palermo, Italy

S- Editor Tian L L- Editor Wang XL E- Editor Lin YP

References
1.  Rampone B, Schiavone B, Martino A, Viviano C, Confuorto G. Current management strategy of hepatocellular carcinoma. World J Gastroenterol. 2009;15:3210-3216.  [PubMed]  [DOI]  [Cited in This Article: ]
2.  Braillon A, Nguyen-Khac E. Hepatocellular carcinoma: a pledge for evidence-based medicine. Am J Med. 2008;121:e7; author reply e11-e17; author reply e12.  [PubMed]  [DOI]  [Cited in This Article: ]
3.  Agence de Biomédecine. Rapport annuel 2007.  Available from: URL: http://www.agence-biomedecine.fr/uploads/document/rapp-synth2007.pdf. Accessed July 22, 2009.  [PubMed]  [DOI]  [Cited in This Article: ]
4.  Conférence de consensus. Indications de la transplantation hépatique. 19 et 20 janvier 2005.  Available from: URL: http://www.has-sante.fr/portail/upload/docs/application/pdf/Transplantation_hepatique_2005_court.pdf. Accessed July 22, 2009.  [PubMed]  [DOI]  [Cited in This Article: ]