Surgery for Recurrent Hepatocellular Carcinoma

Abstract

Objective: To evaluate the long-term outcomes of surgery for recurrent hepatocellular carcinoma (HCC). Background: HCC recurs with high incidence after liver resection. Little is known about long-term outcomes of patients undergoing surgery for recurrent HCC. Methods: Among 989 patients who underwent R0/R1 liver resection for HCC between 1995 and 2014, 676 patients who exhibited recurrence were included. Repeat surgery was performed in 128 patients (RS group), and not in the remaining 548 patients (NS group). Prognostic value after repeat surgery was evaluated by comparing survival after recurrence (SAR) between the RS and NS groups. Subgroup analyses according to the 3 recurrence patterns [intrahepatic recurrence (IHR), extrahepatic recurrence (EHR), and intra plus extrahepatic recurrence (IHR + EHR)] were performed. Results: Seventy-three of 430 patients (17.0%) with IHR, 17 of 57 patients (29.8%) with EHR, and 38 of 189 patients (20.1%) with IH + EHR underwent repeat surgery. Compared with the NS group, the RS group had better liver function and their time to recurrence was significantly longer (16.5 vs 11.4 months; P < 0.001). In the overall and 3 recurrence patterns, the 5-year SAR rate was better in the RS group compared with the NS group (RS vs NS group; overall, 53.0% vs 25.7%; IHR, 73.8% vs 37.2%; EHR, 30.0% vs 0%; IHR + EHR, 34.1% vs 10.6%; all P < 0.001, respectively). On multivariate analysis, repeat surgery was identified as an independent factor for better SAR (P < 0.001). Conclusion: Surgery for recurrent HCC may yield long-term survival for not only IHR but also for EHR in selected patients.

Early Versus Late Recurrence of Hepatocellular Carcinoma After Surgical Resection Based on Post-recurrence Survival: an International Multi-institutional Analysis

“…Thus, early-recurring tumors have generally been more associated with aggressive characteristics and worse outcomes. [ 15,18 ] Risk stratification to identify patients most at risk for early recurrence is clinically important in the postoperative setting to plan screening and surveillance for recurrence. [ 5 ] In addition, several investigators have even suggested that patients at risk of early HCC recurrence may benefit from adjuvant treatments, including intra-arterial therapy, as well as be screened for enrollment in clinical trials given that there is no established standard adjuvant care for high-risk patients.…”

Early diagnosis and therapeutic strategies for hepatocellular carcinoma: From bench to bedside

“…Although LR can achieve a 5-year overall survival (OS) of 60%-70%[ 49 ], the high incidence of HCC recurrence following LR remains a major challenge. Among patients with intrahepatic recurrence or extrahepatic recurrence after resection, re-LR may improve long-term survival[ 50 ].…”

New frontiers in liver resection for hepatocellular carcinoma

“…In a recent study from Yoh et al. , 176 the authors investigated the long-term results of repeat surgery in various conditions of recurrence, including intra and/or extrahepatic disease in more than 600 patients. Interestingly, in selected patients with the best hepatic functional reserve and longer time to recurrence, surgical treatment of recurrence was beneficial not only for intrahepatic recurrence but also in cases of extrahepatic disease.…”