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Invited Critique |

Impact of Histological Grade of Hepatocellular Carcinoma on the Outcome of Liver Transplantation—Invited Critique

Robert Rick Selby, MD
Arch Surg. 2001;136(1):31. doi:10.1001/archsurg.136.1.31.
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Hepatocellular cancer is increasingly common in the age of chronic hepatitis B and C. Because of residual chronic hepatitis and tendency of tumor recurrence in the native liver, transplantation rather than hepatic resection is more likely to result in a successful outcome. Certain tumor descriptors exist that allow us to preoperatively stage tumors and assess the potential for recurrence following transplantation. Typically these descriptors include size, number of lesions, bilobar disease, macroscopic intrahepatic vascular invasion (into portal or hepatic venous radicals visible on contrast computed tomographic scanning), capsular invasion with local extension, and nodal or distant disease. All of this information can usually be obtained with the noninvasive high-quality imaging now available. Actual microvascular invasion can only be seen on the explanted specimen, so it is not available to factor into the preoperative decision making. However, microvascular invasion by itself can only result in a stage III designation—a stage that is not a contraindication for transplantation.

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