Median operative time was 600 min, range MAPK inhibitor 340–989 min, and the length of stay was 19 days, range 15–38 days. Infection (median 11%, range 5–21%), biliary (median 5%, range 0–31%), bleeding (median

7%, range 0–33%), and vascular (median 7%, range 0–12%) complications were most commonly recorded. Two studies reported 23–24% reoperation rates, but no other reoperations occurred in any other study.[23, 30] Acute rejection occurred in 4%, range 0–12%, of patients. Four patients required retransplantations. Median mortality rate was 5%, range 0–24% (Table 6). The median follow-up was 29 months, range 11–77 months. Median disease-free survival was not yet reached in 10 of the studies. The median 1-year disease-free survival was 86%, range 47–100%; median 3-year disease-free survival was 68%, range 29–100%; and median 5-year disease-free survival was 67%, range 29–100%. Two studies reported a median overall survival of 45.6 and 61 months;[20, 31] however, the remaining 14 studies had not yet reached median overall survival at publication of results. The median 1-year overall survival was 89%, range 59–100%; median 3-year overall survival was 80%, range 52–100%; and median 5-year overall survival was 62%, range 41–89%

(Table 7). Primary liver transplantation is recognized as the most effective treatment of primary HCC within the Milan criteria, but is limited by organ shortage.[36] Efficacy of this treatment is affected by disease progression during PD-0332991 cell line prolonged waiting times.[8] Primary hepatic resection is a widely adopted modality of treatment for primary HCC with reasonable long-term survival outcomes but is associated with high rates of disease recurrence. Poon et al. suggest a treatment strategy of primary hepatic resection as the treatment of patients with HCC within the Milan criteria, with SLT reserved MCE公司 for those with disease recurrence.[8] This strategy may potentially reduce

disease progression for patients waiting for liver transplantation and reduce the number of transplantations required. The pathological specimen obtained from a primary resection can also assist surgeons in identifying those patients at high risk of recurrence, who would most likely benefit from an SLT.[16, 37] The theoretical rate of patients eligible for SLT at recurrence has been reported to be as high as 60–80%.[8, 38] Although early clinical studies demonstrated the relative safety of this treatment strategy,[14, 20] there have been concerns about prior primary resection increasing the difficulty of SLT, negating potential outcome benefits. Inclusion criteria for primary hepatic resection were generally consistent among studies. Initial resection was indicated in patients with good residual hepatic function, few tumor nodules (ideally solitary nodule), absence of intraoperative evidence of macrovascular invasion, absence of extrahepatic malignancy, and anatomically resectable disease.