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Resumen
La cirrosis es una enfermedad preneoplásica (la probabilidad de desarrollar un hepatocarcinoma a los 5 años es del 20%). El tratamiento curativo del hepatocarcinoma es la exéresis quirúrgica radical mediante resección o trasplante. No existen estudios prospectivos y aleatorizados que comparen la resección frente al trasplante. La supervivencia global a 5 años, con ambas técnicas en casos seleccionados, es superior con el trasplante (60-80%) que con la resección (30-50%). Además, la recurrencia tumoral a largo plazo es muy superior con la resección (70-100%) que con el trasplante (10-20%). En circunstancias ideales de tratamiento (adecuada selección, baja morbimortalidad, disponibilidad de órganos, etc.), el trasplante es una técnica superior, ya que trata simultáneamente la enfermedad tumoral y la enfermedad primaria. No obstante, la recidiva de la enfermedad original (virus C) y los efectos de la inmunosupresión crónica pueden empeorar los resultados a largo plazo.
Palabras clave:
Hepatocarcinoma
Hepatectomía
Trasplante hepático
Cirrhosis is a preneoplastic disease and the probability of developing hepatocarcinoma at 5 years is 20%. Curative treatment of hepatocarcinoma is radical surgical excision through resection or transplantation. No prospective randomized studies comparing resection with transplantation have been published. When these techniques are performed in selected patients, overall 5-year survival is higher with transplantation (60-80%) than with resection (30-50%). Moreover, tumoral recurrence in the long term is much higher with resection (70-100%) than with transplantation (10-20%). When the circumstances of treatment are ideal (appropriate patient selection, low morbidity and mortality, available organs, etc.) transplantation is the superior technique since it treats both the tumoral and the underlying disease simultaneously. Nevertheless, recurrence of the original disease (hepatitis C virus) and the effects of chronic immunosuppression may adversely affect the long-term results.
Key words:
Hepatocarcinoma
Hepatectomy
Liver transplantation
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