Patterns, timing, and predictors of recurrence after laparoscopic liver resection for hepatocellular carcinoma: results from a high-volume HPB center

Abstract

Background Although long-term outcomes may be comparable between laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC), there has been little discussion regarding the patterns of recurrence after LLR. Methods Patients with HCC who underwent hepatectomy between April 2015 and November 2018 were included in this study. The recurrence patterns were analyzed in detail. The recurrence outcomes following laparoscopic versus OLR for HCC were compared after 1:2 propensity score matching. Potential risk factors for recurrence were also assessed with Cox proportional risk models. Results Among 425 patients after LLR, 144 (33.8%) experienced recurrence at the last follow-up, with a median recurrence-free survival (RFS) of 10.0 months (range 1–58 months). The most frequent recurrence site was the liver (n = 99, 68.8%), followed by the surgical margin (n = 15, 10.4%) and distant metastases (n = 12, 8.3%). Liver recurrence with distant metastasis (n = 10, 6.9%) tended to occur early (median 8.0 months), while peritoneal recurrence (n = 8, 5.6%) occurred later (median 14.0 months). A total of 120 (83.3%) patients had recurrence within 2 years after LLR. No trocar site recurrence was observed in this study. The recurrence patterns, timing, and treatment did not show significant differences between the LLR and OLR. The independent risk factors for recurrence included ALBI grade, postoperative α-fetoprotein > 8 ng/ml, tumor size > 5 cm, surgical margin ≤ 1 cm, and multiple tumors. Patients with recurrence had 1- and 5-year overall survival rates of 81.1% and 60.7%, respectively, compared with rates of 95.8% and 92.9% for patients without recurrence (P < 0.000). Conclusion This study suggested that intrahepatic recurrence was still the most common recurrence pattern for HCC after LLR and that LLR did not increase the risk of trocar hole recurrence or implantation. Most cases of recurrence occurred within 2 years after LLR, suggesting that surveillance should be targeted to early recurrence.

A Rare Cause of Haemorrhagic Shock: Rupture of Gastric Wall Seeding of Hepatocellular Carcinoma

“…HCC can lead to peritoneal dissemination (5.6%) [6]. In this patient, a ruptured HCC had previously been implanted into the gastric wall, and this time, the implanted lesion ruptured, resulting in haemorrhagic shock.…”

“…e most frequent recurrence site is the liver. Extrahepatic metastases most commonly involve the lungs, lymph nodes, bones, and adrenal glands [2,3,6].…”

“…In many cases of postoperative recurrence after resection of HCC, tumour recurrence is seen in the remaining liver tissue [6]. While extrahepatic recurrence of HCC is usually caused by haematogenous metastasis, lymphatic and disseminated metastasis is rare [2].…”

A Hybrid Machine Learning Model Based on Semantic Information Can Optimize Treatment Decision for Naïve Single 3–5-cm HCC Patients

“…There have been some studies on the predicted recurrence of HCC after resection or thermal ablation [10,17,[19][20][21][22][23], which mainly divided patients into high-risk and low-risk groups using predictive models, and then observe differences in tumor recurrence. These often recommend the high-risk patients to undergo transcatheter arterial chemoembolization, chemotherapy, or target therapy after the first treatment to enhance or consolidate treatment benefits [22,23].…”

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Taiwan perspective

“…23 Accurate identification of the tumor (T) stage is crucial to extending the disease-free survival after curative treatment because tumor size, tumor number, and microvascular invasion are significant predictors of survival. 24,25 These tumor characteristics can be examined through preoperative imaging, such as dynamic CT and MRI. 26 The strengths of MRI include low operator dependence, no radiation exposure, and the ability to analyze the liver parenchyma in its entirety.…”