Repeat hepatic resection <i>versus</i> radiofrequency ablation for recurrent hepatocellular carcinoma: retrospective multicentre study

Zhong, Jian‐Hong; Xing, Baocai; Zhang, W G; Chan, Anthony Wing–Hung; Chong, Charing C.N.; Serenari, Matteo; Peng, Ning; Huang, Tao; Lu, Sicong; Liang, Zhi‐Yin; Huo, Rong‐Rui; Wang, Y Y; Cescon, Matteo; Liu, T Q; Li, L; Wu, Feixiang; Ma, Liang; Ravaioli, Matteo; Neri, Jacopo; Cucchetti, Alessandro; Johnson, Philip J.; Xiang, B-D.

doi:10.1093/bjs/znab340

Cited by 22 publications

(32 citation statements)

References 36 publications

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“…In a recent monocentric report from Singapore, re-resection was associated with a late survival benefit but displayed a higher procedural morbidity rate [ 41 ]. In contrast, combined data from China and Italy displayed longer RFS upon re-resection but failed to convey an improved OS compared to RFA [ 42 ]. Similar to the report by Chua et al, morbidity was also higher after re-resection in this study [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

The role of re-resection in recurrent hepatocellular carcinoma

Bednarsch

Czigány

Heij

et al. 2022

Langenbecks Arch Surg

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Purpose While liver resection is a well-established treatment for primary HCC, surgical treatment for recurrent HCC (rHCC) remains the topic of an ongoing debate. Thus, we investigated perioperative and long-term outcome in patients undergoing re-resection for rHCC in comparative analysis to patients with primary HCC treated by resection. Methods A monocentric cohort of 212 patients undergoing curative-intent liver resection for HCC between 2010 and 2020 in a large German hepatobiliary center were eligible for analysis. Patients with primary HCC (n = 189) were compared to individuals with rHCC (n = 23) regarding perioperative results by statistical group comparisons and oncological outcome using Kaplan–Meier analysis. Results Comparative analysis showed no statistical difference between the resection and re-resection group in terms of age (p = 0.204), gender (p = 0.180), ASA category (p = 0.346) as well as main preoperative tumor characteristics, liver function parameters, operative variables, and postoperative complications (p = 0.851). The perioperative morbidity (Clavien-Dindo ≥ 3a) and mortality were 21.7% (5/23) and 8.7% (2/23) in rHCC, while 25.4% (48/189) and 5.8% (11/189) in primary HCC, respectively (p = 0.851). The median overall survival (OS) and recurrence-free survival (RFS) in the resection group were 40 months and 26 months, while median OS and RFS were 41 months and 29 months in the re-resection group, respectively (p = 0.933; p = 0.607; log rank). Conclusion Re-resection is technically feasible and safe in patients with rHCC. Further, comparative analysis displayed similar oncological outcome in patients with primary and rHCC treated by liver resection. Re-resection should therefore be considered in European patients diagnosed with rHCC.

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Section: Discussionmentioning

confidence: 99%

The role of re-resection in recurrent hepatocellular carcinoma

Bednarsch

Czigány

Heij

et al. 2022

Langenbecks Arch Surg

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“…HCC recurrence, which was assessed by the investigators (J.-H.Z, Y.-X.T, K.C), was diagnosed using enhanced computed tomography and/or MRI [including gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI] with or without alpha fetoprotein ≥400 ng/mL) ( 18 ). Patients with HCC recurrence would be received appropriate therapeutic approaches, with radiofrequency ablation and repeat liver resection as the preferred curative treatments ( 25 , 26 ). Postoperative mortality was defined as the rate of death within 30 days after liver resection.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Liver Resection for Metabolic Dysfunction-Associated Fatty Liver Disease or Chronic Hepatitis B-Related HCC

et al. 2022

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AimsThis study aims to determine differences in severity of background liver disease at hepatocellular carcinoma (HCC) diagnosis and long-term survival outcomes among patients undergoing liver resection for HCC in the background of metabolic dysfunction-associated fatty liver disease (MAFLD) compared to chronic hepatitis B (CHB) alone or concurrent CHB (CHB/MAFLD).MethodsPatient demographics and comorbidities, clinicopathologic data, perioperative and long-term outcomes among patients who underwent liver resection for HCC were reviewed. Overall and recurrence-free survival were calculated with the Kaplan-Meier method, with the values compared using the log-rank test.ResultsFrom January 2014 to December 2018, 1325 patients underwent potential curative liver resection of HCC; 67 (5.0%), 176 (13.3%), and 1082 (81.7%) patients had MAFLD alone, CHB concurrent with MAFLD, and CHB alone, respectively. At HCC diagnosis, fewer MAFLD patients had cirrhosis, alpha fetoprotein concentration ≥ 400 ng/mL, tumor size ≥ 5 cm, mulinodular, microvascular invasion, receiving major hepatectomy, and receiving adjuvant transarterial chemoembolization. After a median follow-up of 47 months after liver resection, MAFLD (or MAFLD plus CHB/MAFLD) patients had significantly higher overall and recurrence-free survival than CHB patients before or after propensity score analysis (all P<0.05).ConclusionPatients with HCC in the setting of MAFLD have less-severe background liver disease at HCC diagnosis and better long-term survival after curative liver resection compared to counterparts with CHB/MAFLD or CHB.

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“…Even after treatment of recurrent disease, a large number of patients will develop a second recurrence with a reported incidence of 50–70%. 19 , 20 Some patients may even go on to develop a third or fourth recurrence after previous curative-intent treatment. While this is uncommon, the data that are available suggest that each successive curative-intent procedure is associated with diminishing probability of long-term survival.…”

Section: Patterns Of Hcc Recurrence and Risk Factorsmentioning

confidence: 99%

“…Other studies have failed, however, to confirm a long-term survival benefit of repeat resection over ablation. 20 , 56 , 57 The comparability of repeat resection and ablation relative to long-term outcomes following treatment of recurrent HCC was particularly pronounced among patients with early recurrence. In particular, several studies have noted no difference in outcomes following repeat resection versus ablation among patients with recurrent HCC who met Milan criteria or had early-stage disease according to the Barcelona Clinic Liver Cancer (BCLC) classification.…”

Section: Staging and Treatment Of Recurrent Hccmentioning

confidence: 99%

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Recurrent Hepatocellular Carcinoma: Patterns, Detection, Staging and Treatment

Papaconstantinou¹,

Tsilimigras²,

Pawlik³

2022

JHC

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Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide with the incidence of recurrence being as high as 88% even among patients who have undergone curative-intent treatment. Despite improvements in overall survival, recurrence remains a challenge necessitating accurate reappraisal of patient and disease status. To that end, accurate staging of recurrent HCC is a necessity to provide better care for these patients. Risk factors for poor survival after HCC recurrence have been identified and include characteristics of the primary disease, such as tumor multifocality, large size (≥5 cm), macroscopic vascular or microscopic lymphovascular invasion, preoperative a-fetoprotein (AFP) levels, R0 resection, and the presence of impaired liver function. Close surveillance with imaging is warranted following curative-intent therapy, with magnetic resonance imaging (MRI) being the preferred approach to identify small, early recurrent HCCs. Treatment decisions at the time of recurrence involve ruling out extrahepatic disease and identifying candidates for potentially curative-intent repeat treatment options. Patients with recurrent disease are, however, very diverse in terms of tumor morphology and biologic behavior, as well as residual hepatic functional reserve. Patients with preserved liver function may benefit from repeat liver resection or ablation. Patients with recurrence within the Milan criteria may even be candidates for salvage liver transplantation, while multimodality treatment with combination of liver-directed therapies appears to enhance oncologic outcomes for individuals with advanced recurrent disease. A “one-size-fits-all” approach in staging recurrent HCC does not exist. Rather, individualized and evidence-based decision-making is necessary in order to optimize outcomes for patients with recurrent HCC.

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Repeat hepatic resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: retrospective multicentre study

Cited by 22 publications

References 36 publications

The role of re-resection in recurrent hepatocellular carcinoma

The role of re-resection in recurrent hepatocellular carcinoma

Outcomes of Liver Resection for Metabolic Dysfunction-Associated Fatty Liver Disease or Chronic Hepatitis B-Related HCC

Recurrent Hepatocellular Carcinoma: Patterns, Detection, Staging and Treatment

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