| セッション情報 |
International Forum 2(Liver) 4.Treatment Strategy
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| タイトル |
IF2-4-II (Keynote lecture) Resection and Transplantation for HCC
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| 演者 |
Jacques Belghiti（Hepatobiliopancreatic and Liver Transplantation DepartmentHospital BeaujonClichyFrance） |
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| 抄録 |
Over the past 10 yearsthere has been considerable progress in the surgical treatment of HCC including adramatic improvement of surgical resections． The high rate of recurrenceespecially in patients withchronic liver disease （CLD） leads the majority of western centers to consider Liver Transplantation （LT）for patients with CLD who fulfill Milano criteria． Although LT is the best treatment for selected patientsliver resection remains the major surgical treatment because more than 95% of patients with HCC are noteligible for LT． Furthermoreeven in good candidates for LTthe increase in waiting timewhich is associ-ated with tumor progressionlead us to consider in some patients surgical resection before LT．Althoughwe have to face with an increasing number of patients with HCC associated with metabolic syn-dromethe presence of CLD in the majority of patients with HCC explains the increasing incidence of thistumor in endemic areas for viral hepatitis and especially hepatitis C．Even in good candidates for LTthe increase in waiting timewhich is associated with tumor progressionlead many authors to consider tumor ablation before LT． The tumor management while awaiting trans-plantation can include hepatic resection which does not increase the surgical risk nor impair the survivalof LT． Resection can be used as a bridge treatment before LTas a selection of good candidates based onthe specimen analysis and as an initial treatment of HCC indicating LT in case of recurrence or deteriora-tion of liver function （salvage transplantation） ． ln patients with good liver function and peripheral tumorsresection can be considered as the most efficient bridge treatment since it removes completely the tumor．The complete ablation of the specimen allows a precise pathological assessment of unfavorable histologicalprognostic factors which could not be established preoperatively including the degree of differentiation indifferent areas of the tumor ； micro vascular invasion and presence of satellite nodules． Thenthe indica-tion of transplantation could be based on these histological factors with several possibilities including anacceleration of the process of LT in some cases with microvascular invasion or a contra-indication if amacrovasular invasion is discovered on the specimen． The concept of resection as the initial treatment ofHCC with salvage transplantation in case of recurrence is the most attractive approach． After a curativeresection of HCC with good histological prognosispatient underwent a close follow-up for detecting re-currence and then transplanted． ln an era of graft shortageliver resection is immediately applicabletech-nically simplernot associated with immunosuppression． After resection of limited HCC80% of patientswith HBV infection remained eligible for transplantation at the time of recurrence． However 60% of pa-tients with HCV infectionwho experienced recurrencewere no more eligible for transplantation at thetime of recurrence in our experience． This important result didn’ t modify our policy of resection in pa-tients with small HCC in patients with good liver functionbut after resection patients with HCV infectionare maintained in the waiting list and transplanted before recurrence． |
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