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Liver Resection Versus Transplantation for Hepatocellular Carcinoma within Milan Criteria: An Intention-to-treat Analysis
이식 가능한 간암에 대한 간절제술과 뇌사자 간이식의 비교: 치료의향분석
Korean Journal of HBP Surgery 2010 Mar;14(1):30-6
Published online March 31, 2010
Copyright © 2010 Korean Journal of Hepato-Biliary-Pancreatic Sursery.

Yang Won Nah, M.D., Chang Woo Nam, M.D., Neung Hwa Park, M.D.1, Jung Woo Shin, M.D.1
나양원, 남창우, 박능화1, 신정우1

Departments of Surgery and 1Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine
울산대학교 의과대학 울산대학교병원 외과학교실, 1내과학교실
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: Postoperative as well as intention-to-treat outcomes of deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC) within the Milan criteria were compared to outcomes for patients who underwent liver resection. The goal was to select the optimal therapeutic option for these patients.
Methods: Among 1363 patients diagnosed with HCC between Jan 2001 and Sep 2008, 57 underwent liver resection for HCC within the Milan criteria (LRX group) and 47 registered for DDLT (WAIT group). Thirteen patients underwent DDLT (LTX group), including 2 salvage DDLT for recurrent HCC after resection. The outcomes for the LRX group were compared with those for the LTX and WAIT groups.
Results: Child class B or C patients accounted for 5% in the LRX group and 81% in the WAIT group (p=0.000). Among 47 registrants in the WAIT group, 11 underwent DDLT after a mean waiting time of 282 days (LTX group). Tweleve patients were dropped from the waitlist due to death or disease progression after a mean time of 317 days after registration. There was 1 operative death in the LTX group 14 days after DDLT due to primary graft nonfunction. The 3-year overall and disease-free survival rates were comparable between the LRX and LTX groups. On the other hand, the LRX group showed a significantly better intention-to-treat outcome than the WAIT group. The 3-year survival rates were 80.4% for the LRX group and 52.0% for the WAIT group (p=0.002).
Conclusion: For HCC patients within the Milan criteria, liver resection should be considered as their primary option of treatment in Korea, where the DDLT rate is below 6%.
Keywords : Hepatocellular carcinoma, Treatment, Liver resection, Liver transplantation

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