• Stefano Di Sandro, Carlo Sposito, Andrea Lauterio, Marc Najjar, Michele Droz Dit Busset, Vincenzo Buscemi, Maria Flores Reyes, Riccardo De Carlis, Vincenzo Mazzaferro, and Luciano De Carlis.
• Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Surgical Sciences, University of Pavia, Pavia, Italy. Electronic address: stefano.disandro@ospedaleniguarda.it.
• J. Am. Coll. Surg. 2018 Jun 1; 226 (6): 1147-1159.

BackgroundTransplantable hepatocellular carcinoma (HCC) represents a highly debated issue due to the overlap between indications for liver resection (LR) and transplantation (LT) in patients suitable for both.Study DesignBetween January 2000 and December 2012, five hundred and twenty-four transplantable patients affected by HCC were identified among resected patients. Two regression models were constructed to classify patients into 2 groups pre-low and pre-high risk based on preoperative variables and then to reclassify pre-low-risk patients according to postoperative variables into either post-low or post-high-risk. Additionally, a cohort of patients with comparable baseline characteristics who underwent LT were similarly classified into pre-low and pre-high-risk groups and compared with the resected patients in terms of survival.ResultsCirrhosis, aspartate transaminase, α-fetoprotein, Model for End-Stage Liver Disease score, number of nodules, and diameter of the largest nodule were preoperatively found to be significantly related to overall survival post-LR. Microvascular invasion and satellites were selected to reclassify prognosis in the resulting preoperative low-risk group into post-high risk. The converted group (post-high) demonstrated the same 5-year survival as the pre-high group. Patients undergoing LT had better survival overall than those undergoing LR, with the exception of pre-low LT and post-low LR (confirmed low-risk LR) who had similar outcomes.ConclusionsThe new models were strongly predictive of patients' likelihood of survival after LR for HCC on liver cirrhosis. Liver transplantation offers a survival advantage over LR, except in low-risk groups where both modalities might be comparable.Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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