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KMID : 0614720130560110956
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Journal of Korean Medical Association
2013 Volume.56 No. 11 p.956 ~ p.963
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Recent advances in hepatic resection and liver transplantation for hepatocellular carcinoma
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Hwang Shin
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Abstract
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For single hepatocellular carcinoma(HCC), hepatic resection (HR) is regarded as the treatment of choice regardless of size when hepatic function is preserved. Systematic HR is preferred, but an individual patient-customized treatment plan for HR is essential to ensure patient safety as well as to achieve oncologic curability. HR can offer an acceptable survival outcome for patients with small oligo-nodular HCCs and well-preserved liver function. For HCC patients with portal vein tumor thrombus, HR with thrombus removal can lead to improved outcomes comparing with non-surgical treatments. Liver transplantation (LT) is a treatment that offers a chance of a cure for HCC and the underlying liver cirrhosis simultaneously, but the availability of liver grafts and the aggressi-veness of tumor recurrence are critical limiting factors of LT for patients with HCC. In Korea, the shortage of deceased donors and strong demand for LT has led to the development of living-donor LT. Considering that HCC recurrence is the most common cause of post-transplant patient death, recipient candidates should be prudently selected through objectively established criteria. The eligibility criteria for LT for HCC are likely to be expanded, but this will require further qualified risk-benefit analyses. HR and LT have complementary roles; thus they should be considered associated treatments rather than mutually exclusive alternatives. A multi-modality treatment strategy, especially for patients with advanced HCC, provides new fields of investigation for diverse indications of HR and LT.
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KEYWORD
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Hepatocellular carcinoma, Hepatectomy, Liver transplantation, Recurrence, Hepatic failure
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