ObjectiveTo evaluate the safety and technical feasibility of salvage liver transplantation (SLT) after liver resection, and its influence on prognosis. MethodsThe clinical data of 289 patients who underwent liver transplantation by cadaveric grafts treating for hepatocellular carcinoma met the UCSF criteria from June 2001 to December 2008 were analyzed retrospectively. Among them, 242 patients underwent primary liver transplantation (PLT, PLT group), and 47 patients underwent SLT for recurrence (SLT group). Perioperative factors and survival were compared between two groups. ResultsThere were no significant differences of age, gender, and pathology of tumor between two groups (Pgt;0.05). The operation time in the SLT group was significantly longer than that in the PLT group 〔(7.1±1.8) h versus (6.4±1.4) h， P=0.004〕. The differences of intraoperative blood loss 〔(2 560.5±2 683.6) ml versus (2 042.9±2 006.2) ml， P=0.173〕 and blood transfusion 〔(13.8±12.9) U versus (9.9±12.6) U， P=0.087〕 were not significant between two groups. The mean interval time from resection to transplantation was (32.8±32.4) months. The median followup was 38.7 months, 3year overall and diseasefree survivals were not significantly different (82.3% versus 75.5%, P=0.312; 78.8% versus 70.1%, P=0.755, respectively) between the SLT group and PLT group. According to intentiontotreat analysis, the 3year overall survival in the SLT group was significantly longer than that in the PLT group (88.4% versus 76.2%, P=0.047). ConclusionsIn selected patients, liver resection prior to transplantation neither increases operative morbidity nor impairs prognosis following liver transplantation. SLT after liver resection, can be an alterative treatment for HCC.
Objective Exploring the way to obtain long-term, high-quality survival of patients with primary liver cancer (PLC) by surgical resection. MethodReviewing the diagnosis, treatment and follow-up outcomes of 10 PLC patients who were most representative, confirmed by pathology and survived for 30 years or more after surgical treatment at Zhongshan Hospital, Affiliated to Fudan University from July 1958 to September 1995, and summarizing the successful experiences with references. ResultsCase one: male, 50-year-old. Case one survived for forty-three years of long-term survival after surgery, who was the ealiest one to break the 40-year survival barrier. Case 2: female, 36-year-old. Case 2 had remained tumor-free survival for 57 years after liver resection: the longest record of high-quality survival to date. Case 3: male, 31-year-old. Case 3 had remained 51-year tumor-free survival after resection of a giant (17 cm) hepatocellular carcinoma. Case 4: male, 19-year-old. The patient, suspected of liver cancer based only on abnormally elevated alpha-fetoprotein (AFP) in the 1970s, underwent surgical exploration with immediate liver cancer resection, and had since enjoyed 50 years of tumor-free survival. Case 5: male, 59-year-old. The patient survived to be 103 years old after undergoing liver cancer resection and subsequent pulmonary metastasis resection with tumor-free survival of 43 years. Case 6: female, 19-year-old. The patient survived 50 years after undergoing liver cancer resection. Her liver cancer was found on abnormally elevated AFP in liver cancer screening in the 1970s. She gave birth to a healthy baby girl 10 years after the operation. Now the mother and daughter lead a happy life. Case 7: male, 44-year-old. The patient with a massive liver cancer undervent three sequential surgical interventions: hepatic artery ligation and cannulation, hepatectomy for the primary tumor, and re-resection of recurrent tumor. He had survived for 45 years postoperatively and well. Case 8: male, 57-year-old. The patient with liver cancer accompanied by thrombus in the left hepatic vein and survived for 38 years after undergoing an En Bloc liver cancer resection including removal of the cancer thrombus. Case 9: male, 48-year-old. The patient with hilar liver cancer (segment Ⅷ) had been living healthily for 32 years after a thrilling liver resection. Case 10: 18-month-old, baby girl. The female infant survived 32 years after undergoing liver cancer resection. Now she had grown up, gotten married, had her own children, and the family is living a happy life. ConclusionSurgical resection is the most thorough treatment method, enabling liver cancer patients to achieve long-term or even miraculous survival outcomes.