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Journal of Cancer Research and Therapeutics, Vol. 6, No. 2, April-June, 2010, pp. 233-234 Letter to the Editor Role of liver transplantation for surgical management of malignant liver tumors Rajeev Sharma Department of Abdominal Organ Transplantation and Hepatobiliary Surgery, University of Virginia Health System, Surgery Box 800709, Charlottesville, VA 22908, USA Correspondence Address: Dr. Rajeev Sharma, Department of Abdominal Organ Transplantation and Hepatobiliary Surgery, University of Virginia Health System, Surgery Box 800709, Charlottesville, VA 22908, USA. drsharma.r@gmail.com Code Number: cr10053 PMID: 20622377 DOI: 10.4103/0973-1482.65232 Sir, I read with great interest the article by Shukla and Barreto. [1] It is a comprehensive and excellent review of surgical management of malignant liver tumors. However, no article about the surgical management of liver tumors is complete without a brief discussion of the role of liver transplantation (LT). Surgical resection remains the treatment of choice for hepatocellular carcinoma (HCC) in non-cirrhotic patients or in those with cirrhosis but well-preserved liver function, normal bilirubin, and hepatic vein pressure gradient < 10 mmHg. [2] However, after resection, tumor recurrence rate exceeds 70% at 5 years, with the most powerful predictors of recurrence being presence of microvascular invasion and/or additional tumor sites besides the primary lesion. [3] LT is currently recognized as the best treatment option for patients with early HCC and end-stage liver disease. [4] There are no randomized controlled trials comparing LT to other therapies for the management of HCC. While early experience with LT for HCC was disappointing, with 5-year survival rates of approximately 25%, outcomes have significantly improved over time, partially due to the application of stringent eligibility criteria when selecting patients for undergoing LT for HCC. Currently, patients undergoing LT for HCC have a 5-year survival rate exceeding 70%, which is similar to the survival seen in patients undergoing LT for other indications. [3] The observed tumor recurrence rates are less than 15% at 5 years. [3],[5] It has therefore been suggested that LT is an effective option for patients with HCC corresponding to the Milan criteria, [5] i.e., solitary tumor < 5 cm in size or up to three nodules < 3 cm in size. [2] References
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