Surgical treatment for recurrent hepatocellular carcinoma: Current status and challenges

Abstract

Primary liver cancer is the sixth most commonly diagnosed cancer and was the third leading cause of cancer deaths worldwide in 2020. It includes hepatocellular carcinoma (HCC) (representing 75%-85% of cases), intrahepatic cholangiocarcinoma (representing 10%-15% of cases), and other rare types. The survival rate of patients with HCC has risen with improved surgical technology and perioperative management in recent years; however, high tumor recurrence rates continue to limit long-term survival, even after radical surgical resection (exceeding 50% recurrence). For resectable recurrent liver cancer, surgical removal [either salvage liver transplantation (SLT) or repeat hepatic resection] remains the most effective therapy that is potentially curative for recurrent HCC. Thus, here, we introduce surgical treatment for recurrent HCC. Areas Covered: A literature search was performed for recurrent HCC using Medline and PubMed up to August 2022. Expert commentary: In general, long-term survival after the re-resection of recurrent liver cancer is usually beneficial. SLT has equivalent outcomes to primary liver transplantation for unresectable recurrent illness in a selected group of patients; however, SLT is constrained by the supply of liver grafts. SLT seems to be inferior to repeat liver resection when considering operative and postoperative results but has the major advantage of disease-free survival. When considering the similar overall survival rate and the current situation of donor shortages, repeat liver resection remains an important option for recurrent HCC.

Leveraging machine learning for early recurrence prediction in hepatocellular carcinoma: A step towards precision medicine

“…This raises a significant need to improve models for the early detection of patients at risk of recurrence. Many factors have been identified in predicting risk of recurrence of HCC[ 2 ] and this editorial explores the promising avenue in the quest for precision medicine[ 1 ] the development of a machine learning model as highlighted by the authors aimed at predicting early recurrence after surgical intervention[ 7 ]. The advent of machine learning provides a unique opportunity to harness vast datasets, identifying subtle patterns and factors that elude conventional prognostic methods[ 8 , 9 ].…”

Effect of ABO blood group on postoperative overall survival and recurrence-free survival rate in patients with hepatocellular carcinoma after hepatectomy: a multi-center retrospective cohort study

“…Hepatectomy, as the first line of treatment for HCC in patients with preserved liver function, is the best treatment method compared to local ablation and chemoembolization [ 9 – 12 ]. However, the survival rate of these patients is still short and unsatisfactory due to the high recurrence of HCC after hepatectomy [ 13 – 15 ].…”

A novel prognostic signature for hepatocellular carcinoma based on SUMOylation-related genes

“…Over the years, traditional treatments for HCC patients showed poor clinical effects 5 . VI is a significant factor affecting prognosis in HCC 6 . Another study also reported that patients with VI, compared to those without evidence of VI, showed a shorter median survival 7 .…”