For those patients whose poor underlying liver function and tumor number or location preclude hepatic resection, we advocate total hepatectomy with orthotopic liver transplantation (OLT). Although the initial series of OLT for HCC reported poor results, the selection criteria for OLT have subsequently undergone major revision, and more recent results have been favorable. Currently, patients with HCC and cirrhosis with three or less tumor nodules up to 3 cm in maximum diameter or a single tumor not exceeding 5 cm and no signs of vascular invasion should be considered for transplantation. Recent survival data obtained from Milan revealed 4-year survival rates of 75% in patients with solitary tumors that were less than 5 cm who had no vascular invasion (Mazzaferro et al, 1996). Many of the risk factors that predict cancer recurrence following OLT are similar to those that predict a high risk of recurrence after partial hepatectomy, with the major factor being the presence of vascular invasion.
Was this article helpful?