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22
are in agreement with the results achieved in the presented series.
However the role of secondary OLT in patients with recurrence
of tumour after primary treatment by traditional hepatic
resection remains unclear. It seems that the indications
for OLT after primary unsuccessful traditional liver surgery
may be limited due to the high incidence of recurrence of malignancy
after OLT [21, 22]. In the presented series, out of
two patients who underwent secondary OLT, one patient with
TLCT died because of disseminated malignancy, and the follow-up
of another patient with FL-HCC, because of typical
tumour recurrences even after several years [9, 11, 23], is not
long enough to allow any prognostic conclusions.
Results of the presented series together with the results
of other already published series seem to document the
need to differentiate between treatment strategies for malignant
liver cell tumours. This differentiation must consider
not only the size and location of the lesion but also the tumour’s
nature and type, which may lead to different biological
behaviour determining the long-term results. The use of
traditional liver surgery (hepatectomy procedures) seems to
be appropriate for the treatment of smaller lesions of all types
and in the majority of radiologically documented, evidently
resectable HBL cases, with the predictable possibility
of microscopically radical surgery. In cases of giant tumours
and majority of HCC and TLCT cases, the indications for
liver transplantation as a primary surgical treatment should
be considered. Such a strategy based on the biological behaviour
of different malignant liver cell tumour will increase
the possibility of full surgical microscopic radicality significantly
determining the final treatment outcome.
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