Survival Analysis of Re‐resection Versus Radiofrequency Ablation for Intrahepatic Recurrence After Hepatectomy for Hepatocellular Carcinoma

Abstract

BackgroundTumor recurrence after resection of hepatocellular carcinoma is a common phenomenon. Re-resection and radiofrequency ablation (RFA) are good options for treating recurrent HCC. This study compared the efficacy of these two modalities in the treatment of intrahepatic HCC recurrence after hepatectomy.MethodsFrom January 2001 to December 2008, a total of 179 patients developed intrahepatic HCC recurrence after hepatectomy. To treat the recurrence, 29 patients underwent re-resection and 45 patients had RFA. Patient characteristics, clinicopathologic data, and survival outcomes were reviewed.ResultsChild-Pugh status, time to develop first recurrence (12.2 vs. 8.7 months), and recurrent tumor size (2.1 vs. 2.1 cm) were comparable for the two groups. Time to develop a second intrahepatic recurrence after re-resection and RFA was 5.9 and 4.0 months respectively. The 1-, 3-, and 5-year disease-free survival rates were 41.4%, 24.2%, and 24.2% after re-resection and 32.2%, 12.4%, and 9.3% after RFA (p = 0.14). The 1-, 3-, and 5-year overall survival rates were 89.7%, 56.5%, and 35.2% after re-resection and 83.7%, 43.1%, and 29.1% after RFA (p = 0.48). For the second recurrence, 33.3% of patients underwent a second round of RFA and 10.0% underwent a third resection.ConclusionsThe two treatment modalities attained similar survival benefits in the management of recurrent HCC after hepatectomy. The high repeatability of RFA and that it can be delivered percutaneously render it a preferred treatment option for selected patients.

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

“…Furthermore, a recent report showed that it has no survival benefit over RFA for IHR management; LA procedures have advantages of repeatability, minimal invasiveness and hepatic parenchyma preservation. 13 TACE also showed satisfactory results; it carries the same advantages as LA therapy. 10,25 However, it is usually considered to be a palliative treatment.…”

“…[7][8][9][10][11][12][13] SLT has the lowest potential for re-recurrence, with a 5-year DFS rate of 48-67%. 8,11,24 A recent report showed a 5-year DFS rate of 60% after living-donor SLT for recurrent HCC within the Milan criteria.…”

“…6,7 Different modalities have been used for IHR management, including salvage liver transplantation (SLT), re-resection (RR), local ablation (LA) using radiofrequency ablation (RFA) and/or percutaneous ethanol injection (PEI) and trans-arterial embolization/chemo-embolization (TAE/TACE). [7][8][9][10][11][12][13][14] Currently, there are no definitive selection criteria for IHR management other than those applied to the management of primary HCC. 13,15 The pathological features of HCC and non-tumor liver parenchyma (NTLP) are strongly related to recurrence.…”

“…[7][8][9][10][11][12][13][14] Currently, there are no definitive selection criteria for IHR management other than those applied to the management of primary HCC. 13,15 The pathological features of HCC and non-tumor liver parenchyma (NTLP) are strongly related to recurrence. [2][3][4]16 When deciding on therapeutic management options for patients with IHR the pathological features of the primary HCC can also be taken into account.…”

Coupled electrical-thermal model for monopolar and bipolar radiofrequency liver tumor ablation

“…The efficacy of RFA for the treatment of patients with liver tumors has for instance been reported in e.g. [1] and more recently in [2]. Liver cancer is the fourth most common cancer worldwide.…”