Resection or transplant‐listing for solitary hepatitis C‐associated hepatocellular carcinoma: an intention‐to‐treat analysis

ObjectivesThe relative roles of liver resection (LR) and liver transplantation (LT) in the treatment of a solitary hepatocellular carcinoma (HCC) remain unclear. This study was conducted to provide a retrospective intention‐to‐treat comparison of these two curative therapies.MethodsRecords maintained at the study centre for all patients treated with LR or listed for LT for hepatitis C‐associated HCC between January 2002 and December 2007 were reviewed. Inclusion criteria required: (i) an initial diagnosis of a solitary HCC lesion measuring ≤ 5 cm, and (ii) Child–Pugh class A or B cirrhosis. The primary endpoint analysed was intention‐to‐treat survival.ResultsA total of 75 patients were listed for transplant (LT‐listed group) and 56 were resected (LR group). Of the 75 LT‐listed patients, 23 (30.7%) were never transplanted because they were either removed from the waiting list (n = 13) or died (n = 10). Intention‐to‐treat median survival was superior in the LR group compared with the LT‐listed group (61.8 months vs. 30.6 months), but the difference did not reach significance. Five‐year recurrence was higher in the LR group than in the 52 LT patients (71.5% vs. 30.5%; P < 0.001).ConclusionsIn the context of limited donor organ availability, partial hepatectomy represents an efficacious primary approach in properly selected patients with hepatitis C‐associated HCC.