Revista Colombiana de Cirugía
Print version ISSN 2011-7582
HOYOS, Sergio et al. Hepatocellular carcinoma and transplantation: correlation between preoperative evaluation and final pathology result. rev. colomb. cir. [online]. 2009, vol.24, n.2, pp. 76-82. ISSN 2011-7582.
Introduction: Hepatocarcinoma generally develops in cirrhotic patients and its management depends both on the stage of the cirrhotic process and the stage of the tumor, with a registered world-wide increasing incidence. Liver transplant is considered by many the best treatment option with curative intent in those patients that fulfill the corresponding inclusion criteria. Materials and methods: All patients that received hepatic transplant at the Liver Transplant Unit of the Universidad de Antioquia-Pablo Tobón Uribe Hospital (Medellín, Colombia) in the period April 2004-April 2008 were prospectively collected for analysis of diagnostic images and histopathology. Included in the study were patients with the diagnosis of hepatocarcinoma and also those in which the hepatocarcinoma was an incidental finding. Results: Of the 153 transplants performed in the study period, 25 had the diagnosis of hepatocarcinoma established prior to transplantation, and in three patients it was an incidental finding. There were 21 men and 7 women. The etiology of the cirrhotic process was: hepatitis B, 28.6%, hepatitis C, 17.9%, followed by alcoholism, autoimmune disease, and others. In seven patients no hepatocarcinoma was found in the explant, although all had shown a single lesion diagnosed by images as hepatocarcinoma; since none were Child A, the indication for transplantation was a complication of cirrhosis and not the tumor. Correlation between images and pathology in the excised livers was better for MRI than for CT, 53.8% versus 38.8%. Discussion: Liver transplant is the ideal treatment modality for patients with hepatocarcinoma and cirrhosis. It is clear that transplantation is restricted to patients with early stages of the tumor, according to the Milano criteria. In spite of the refinement in the diagnostic imaging techniques, there is still frequent discrepancy between the preoperative imaging findings and the final pathology reports. However, this does not mean that there should be a modification in the treatment of these patients, in view of the satisfactory 5-year survival rates.
Keywords : hepatocarcinoma; carcinoma; hepatocelluar; liver neoplasms; liver transplantation; tomography; X-ray computed; magnetic resonance imaging.