Hepatectomy for hepatocellular carcinoma patients who meet the Milan criteria.

Background/aims: Although hepatocellular carcinoma patients who meet the Milan criteria are optimal candidates for liver transplantation, most such patients in Japan have been treated without liver transplantation.
Methodology: In this retrospective analysis, the patient selection criteria were (1) admission between 1992 and 2005, (2) fulfillment of the Milan criteria, (3) classification within the Barcelona Clinic Liver Cancer stages A1-A4, and (4) no previous anticancer treatment.
Results: Of 451 patients who met the selection criteria, 162 underwent hepatectomy. The proportion of patients who underwent hepatectomy was 58% of 106 with stage A1 and 29% of 345 with stages A2-A4. For patients with stages A2-A4, the survival probability after hepatectomy at 3, 5, and 7 years was 89%, 70%, and 61%, respectively. There were no significant differences in survival time between stages A1 and stages A2-A4 after hepatectomy. Among patients with Child-Pugh scores of 5 and 6 in stages A2-A4, 51% and 29% underwent hepatectomy, respectively.
Conclusions: Hepatectomy may be an appropriate first-line treatment option for patients with stages A2-A4 who meet the Milan criteria, when they have a good hepatic reserve and a long waiting time for liver transplantation.