This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Liberal selection criteria for liver transplantation for hepatocellular carcinoma. BJS 2009; 96: 785-791.
Published: 15th June 2009
Authors: F. Muscari, B. Foppa, N. Kamar, J. M. Peron, J. Selves, B. Suc et al.
Background
To help increase the number of transplants available for hepatocellular carcinoma in cirrhotic livers, this single‐centre retrospective study compared the safety and feasibility of new, more liberal, selection criteria—no more than five tumours, with the largest tumour no greater than 5 cm (5/5 criteria)—with classical criteria.
Method
Data from operations performed in 1990–2005 were extracted from preoperative radiological findings and postoperative specimen analyses, and four groups were constructed: Paul Brousse, Milan, University of California, San Francisco (UCSF) and 5/5 criteria. A fifth group comprised patients whose tumour load exceeded the 5/5 criteria. Survival and recurrence rates were compared.
Results
For the 110 patients in the study, survival rates (overall and disease‐free) were 72·8 and 66·8 per cent at 5 and 10 years respectively, with a 5·5 per cent recurrence rate. The 5‐year survival rate was 65, 77, 68 and 77 per cent for Paul Brousse, Milan, UCSF and 5/5 preoperative radiological criteria, with recurrence rates of 4, 4, 3 and 3 per cent, respectively. On multivariable analysis, the only factor that influenced survival was tumour load in excess of the 5/5 criteria.
Conclusion
Use of the more liberal 5/5 criteria for selecting patients for liver transplantation results in similar disease‐free and overall survival rates to classical criteria. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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