Despite improvements in
therapeutic modalities over the past decade hepatocellular carcinoma (HCC)
remains the second leading cause of cancer related deaths accounting for
approximately 700,000 deaths worldwide each year.
HCC is frequently multifocal and
arises in setting of cirrhosis (>80%), hence surgical resection of HCC with
curative intent is only feasible in 20-30% of patients at time of diagnosis. We
have known for years that liver
transplantation (LT) is the gold standard for HCC therapy in the setting of
significant liver disease given its oncologic advantage of replacing the organ
harboring malignancy all while reversing the physiologic liver dysfunction.
In 1996 Mazzafero et al.
demonstrated that by limiting LT to HCC patients with a single tumor of ≤ 5 cm,
or up to 3 tumor nodules ≤ 3 cm, excellent outcomes could be achieved giving
rise to the influential Milan Criteria.
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