J'Belghiti, M' Chirica, D'Sommacale, F'Dondero, C'Francoz, V'Paradis, D'Valla, A'Sauvanet, F'Durand'

1
Justification for resection as a bridge to
transplantation rather than resection followed
by salvage transplantation in patients with
hepatocellular carcinoma (HCC) and hepatitis C
virus (HCV)-related cirrhosis.

• J. Belghiti, M. Chirica, D. Sommacale,
  F. Dondero, C. Francoz, V. Paradis, D. Valla,
  A. Sauvanet, F. Durand.
• Department of Liver Surgery and Transplantation
  Beaujon Hospital University Paris VII

2
Transplantation

• Small HCC
• 1 nodule lt5 cm
• lt3 nodules, lt3 cm
• No vascular invasion

Survival gt70 Recurrence lt15
3
Bridge treatments

• RFA
• TACE
• Resection

4
Patients Survival after resection of HCC Poon
RT, Fan ST. Surg Oncol Clin N Am 2003
Resection of HCC in Patients Otherwise Eligible
for Transplantation Cha CH, Ruo L, Fong Y et al.
Ann Surg 2003
5
Salvage transplantation
Poon RT et al Ann. Surg. 2002
6
Is this policy always applicable?
Aim of this study Evaluate the applicability
of salvage transplantation in patients with
small HCV-related HCC
7
Patients and methods

• 1990-2004 102 patients underwent hepatic
  resection for HCV related HCC
• Not eligible for LT n55 (54)
• Age gt 65 years n30
• Anesthetic risk n15
• No medical insurance (foreigners) n10
• 47 ( 46) eligible for LT using the Milan
  criteria
• 33 M/ 14 F mean age 58 years ( 8 years)
• Cirrhosis n36 (77)
• Tumoral characteristics 35/47 (74) single
  nodule
• Mean diameter 30 10 mm

8
Results

• Anatomic resection n31 (66)
• Wedge resection
• n16 (34)
• Mortality 4

9
Results
47 patients
Mean follow-up 37 month
Recurrence 23 (49)
Not eligible for salvage LT 14/23 (61)
Salvage LT possible 9/23 (39)
gt 3 nodules 9/14 (64)
1-3 nodules gt 5/3 cm 3/14 (21)
Portal vein invasion 2/14 (14)
Extra-hepatic metastasis 3/14 (21)
10
Recurrence
11
Conclusions

• Most of the patients who underwent hepatic
  resection for HCV-related HCC, were outside the
  Milan criteria at the time of recurrence and were
  no more eligible for salvage LT.
• If liver resection is undertaken for a HCV
  related HCC in a patient otherwise eligible for
  LT, it is imperative that the patient remains on
  the waiting list in order to be transplanted
  before recurrence.
• Resection is just a bridge to transplantation.