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World J Gastrointest Surg. Jan 27, 2013; 5(1): 5-8
Published online Jan 27, 2013. doi: 10.4240/wjgs.v5.i1.5
Primary liver transplantation vs liver resection followed by transplantation for transplantable hepatocellular carcinoma: Liver functional quality and tumor characteristics matter
Mehmet Fatih Can, Christopher B Hughes
Mehmet Fatih Can, Christopher B Hughes, Division of Gastrointestinal Surgery, Department of Surgery, Gulhane School of Medicine, Etlik 06018, Ankara Ankara, Turkey
Mehmet Fatih Can, Thomas Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Author contributions: Both authors equally contributed to the intellectual content and drafting of the manuscript.
Correspondence to: Mehmet Fatih Can, MD, FICS, Assistant Professor, Thomas Starzl Transplantation Institute, University of Pittsburgh Medical Center, Montefiore Hospital 7 South, Pittsburgh, PA 15213, United States.
Telephone: +1-412-9447017 Fax: +1-412-6475480
Received: August 21, 2012
Revised: November 2, 2012
Accepted: December 20, 2012
Published online: January 27, 2013

Liver resection (LR) and primary liver transplantation (LT) are two potentially curative treatment modalities for patients with hepatocellular carcinoma (HCC). If an underlying chronic liver disease exists, however, making a decision on which method should be selected is difficult. If a patient has no chronic liver disease, LR may be the preferable option with salvage transplantation (ST) in mind in case of recurrence. Presence of a moderate-to-severe liver failure accompanying HCC usually warrants primary LT. The treatment of patients with HCC and early-stage chronic liver disease remains controversial. The advantages of “LR-followed-by-ST-if-needed” strategy include less complicated index operation, no need for immunosuppression, use of donor livers for other patients in today’s organ shortage setting and comparable survival rates. However, primary LT has its own advantages as it also treats underlying chronic liver disease with carcinogenic potential, removes undetected tumor nodules and potentially eliminates need for a ST. An article recently published by Fuks et al in Hepatology offers an approach by which selecting between LR-followed-by-ST and immediate LT might be easier. Here we discuss the results of the aforementioned report in the light of currently available knowledge.

Keywords: Hepatocellular carcinoma, Chronic liver disease, Liver transplantation, Liver resection, Salvage transplantation, Survival