Hepatectomy bridges to transplant—the road to cure?

Liver transplantation and hepatic resection are effective surgical strategies for hepatocellular carcinoma(HCC).In the current issue of Annals of Surgery,Professor Pinna and colleagues applied a cure model to compare both treatments(1).Comparison was made in terms of cure rate.Interestingly,curation has never been concisely defined in clinical practise.In the standard survival model,patients are considered disease-free after R0 resection but are always at risk of recurrence.It is arguable,particularly for HCC,whether disease clearance equates curation,as more than half of patients recur in 5 years after radical resection(2).In epidemiology,statistical cure is achieved when the mortality of the patients treated for a specific disease return to that in the general population(3).However,statistical cure is neither practical in clinical sense,as patients surviving with disease are also considered cured.