TY - JOUR
T1 - Hepatocellular Carcinoma in Transplantable Child-Pugh A Cirrhotics
T2 - Should Cost Affect Resection vs Transplantation?
AU - Michelakos, Theodoros
AU - Xourafas, Dimitrios
AU - Qadan, Motaz
AU - Pieretti-Vanmarcke, Rafael
AU - Cai, Lei
AU - Patel, Madhukar S.
AU - Adler, Joel T.
AU - Fontan, Fermin
AU - Basit, Usama
AU - Vagefi, Parsia A.
AU - Elias, Nahel
AU - Tanabe, Kenneth K.
AU - Berger, David
AU - Yeh, Heidi
AU - Markmann, James F.
AU - Chang, David C.
AU - Ferrone, Cristina R.
N1 - Publisher Copyright:
© 2018, The Society for Surgery of the Alimentary Tract.
PY - 2019/6/15
Y1 - 2019/6/15
N2 - Background: There is no consensus regarding the optimal surgical treatment for transplantable hepatocellular carcinoma (HCC) patients with well-compensated cirrhosis. Our aim was to compare outcomes between Child-Pugh A (CPA) cirrhotics who underwent liver resection or transplantation for HCC. Methods: Clinicopathologic data were retrospectively collected for all surgically treated HCC patients between 7/1992 and 12/2015. Disease-free survival (DFS) and overall survival (OS) were calculated from the time of operation or diagnosis (intention-to-treat analysis including patients removed from the transplant list). The average overall cost including pre-operative and post-operative procedures was calculated for each group. Results: Of the 513 surgically treated HCC patients, 184 had CPA cirrhosis and fulfilled the Milan criteria (MC). Of those, 95 (52%) were resected and 89 (48%) were transplanted. Twenty-two patients were removed from the transplant list. Transplanted patients were younger (p < 0.001), had a higher MELD score (p < 0.001) and a higher frequency of hepatitis C (p < 0.001). Length of stay and postoperative complication rates were similar between groups. DFS was longer for transplanted patients (3-, 5-, and 10-year DFS rates 48, 44, 31% vs 96, 94, 94%, respectively, p < 0.001). OS was similar between groups (3-, 5-, and 10-year OS rates 76, 62, 41% vs 82, 77, 53%, respectively, p = 0.07). Only size of greatest lesion and T stage were independent predictors of OS. The cost was much higher for the transplant group, even when accounting for the treatment of recurrences ($37,391 vs $137,996). Conclusions: Since OS is similar between CPA cirrhotics within the MC undergoing resection or transplantation for HCC, but cost is significantly higher for transplantation. Resection should be considered for first-line treatment.
AB - Background: There is no consensus regarding the optimal surgical treatment for transplantable hepatocellular carcinoma (HCC) patients with well-compensated cirrhosis. Our aim was to compare outcomes between Child-Pugh A (CPA) cirrhotics who underwent liver resection or transplantation for HCC. Methods: Clinicopathologic data were retrospectively collected for all surgically treated HCC patients between 7/1992 and 12/2015. Disease-free survival (DFS) and overall survival (OS) were calculated from the time of operation or diagnosis (intention-to-treat analysis including patients removed from the transplant list). The average overall cost including pre-operative and post-operative procedures was calculated for each group. Results: Of the 513 surgically treated HCC patients, 184 had CPA cirrhosis and fulfilled the Milan criteria (MC). Of those, 95 (52%) were resected and 89 (48%) were transplanted. Twenty-two patients were removed from the transplant list. Transplanted patients were younger (p < 0.001), had a higher MELD score (p < 0.001) and a higher frequency of hepatitis C (p < 0.001). Length of stay and postoperative complication rates were similar between groups. DFS was longer for transplanted patients (3-, 5-, and 10-year DFS rates 48, 44, 31% vs 96, 94, 94%, respectively, p < 0.001). OS was similar between groups (3-, 5-, and 10-year OS rates 76, 62, 41% vs 82, 77, 53%, respectively, p = 0.07). Only size of greatest lesion and T stage were independent predictors of OS. The cost was much higher for the transplant group, even when accounting for the treatment of recurrences ($37,391 vs $137,996). Conclusions: Since OS is similar between CPA cirrhotics within the MC undergoing resection or transplantation for HCC, but cost is significantly higher for transplantation. Resection should be considered for first-line treatment.
KW - Cirrhosis
KW - Healthcare cost
KW - Hepatectomy
KW - Hepatocellular carcinoma
KW - Transplantation
UR - http://www.scopus.com/inward/record.url?scp=85053548589&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85053548589&partnerID=8YFLogxK
U2 - 10.1007/s11605-018-3946-z
DO - 10.1007/s11605-018-3946-z
M3 - Article
C2 - 30218342
AN - SCOPUS:85053548589
SN - 1091-255X
VL - 23
SP - 1135
EP - 1142
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 6
ER -