In Western countries, general resection is applicable only to Chi

In Western countries, general resection is applicable only to Child–Pugh class A patients (only non-cirrhosis patients at some institutions). Compared with this, liver transplantation is a potentially ideal treatment because it can also treat the background liver, eliminate the possibility of metachronous multicentric recurrence and does not leave micro-carcinoma in the residual http://www.selleckchem.com/products/FK-506-(Tacrolimus).html liver because the diseased liver is completely resected. Nonetheless, criteria for liver transplantation are stipulated from the perspective of fair allocation of liver grafts, which is a collective societal issue. General tumor

criteria are the absence of extrahepatic metastasis and vascular invasion identifiable with preoperative images, a solitary tumor of 5 cm or less, or if there are multiple tumors, three or fewer tumors measuring 3 cm or less in diameter at a maximum (Milan criteria) (LF005401 level 2a). In the past, the general policy was that resection was selected for patients with resectable tumors, and transplantation was performed in patients who were not candidates for resection but were within in the scope of transplantation candidacy. Recently, however, it was proposed to also conduct http://www.selleckchem.com/products/VX-770.html transplantation in patients with resectable tumors as long as they are within the scope of transplantation candidacy.

Attention should be paid to comparison of the results of these two treatment approaches from this viewpoint. For transplantation, the progression of cancer and dropping out during see more the waiting period are not problems which can be ignored; thus, an intention-to-treat analysis is important. In addition, whether recurrence-free survival or survival should be chosen as an end-point is also a critical

issue. In many cases, institutions recommending transplantation use the superiority of transplantation for recurrence-free survival as a rationale, but the majority of comparisons of survival results showed no difference. In other words, transplantation may ultimately result in postoperative refusal, recurrence of hepatitis, and a risk of death due to complications associated with the use of immunosuppressive drugs. Recurrent hepatocellular carcinoma after transplantation often takes the form of systemic illness so that, in practical terms, there is no effective treatment. In contrast, for recurrence after hepatectomy, effective treatments such as re-hepatectomy, TACE and radio frequency ablation (RFA) can be instituted. Furthermore, the in-hospital mortality (virtually a synonym for operative mortality) after resection or transplantation is a problem which cannot be ignored. Considering these factors, comparison of the two approaches should be performed based on the survival rate which is a gold standard end-point for the results of cancer therapy. References cited below are a comparison of the results of the two at the same institution.

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