The role of re-resection in recurrent hepatocellular carcinoma

Abstract

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.

Laparoscopic versus open liver resection for multiple hepatocellular carcinoma within and beyond the Milan criteria: An Eastern‐Western propensity score–matched analysis

“…However, similar survival analysis in patients with primary and recurrent HCC treated by liver resection have been previously published, showing comparable oncological outcomes, and allowing our comprehensive analysis. 36,37 Furthermore, we decided to include all consecutive cases in order to give a more realistic everyday practice picture about all cases of multiple HCC treated in our institution.…”

Time to surgery is not an oncological risk factor in HCC patients undergoing liver resection

“…Preoperatively, all patients were evaluated for general performance, operability, and liver function as previously described [ 14 , 15 ]. Standard staging procedures were carried out by means of MRI or CT to define tumor burden and exclude distant metastasis.…”

“…Liver resection was carried out as described previously and carried out in accordance with department-specific surgical standards in every case [ 14 , 15 ]. Intraoperatively, ultrasound was used to visualize tumor spread and exclude additional suspect lesions.…”

Recent advances in recurrent hepatocellular carcinoma therapy

“…After 18 mo of initial hepatectomy, repeat hepatectomy may be suggested as a treatment for recurrent HCC. When compared to patients with intrahepatic metastasis, repeat hepatectomy improves survival rates in HCC patients with multicentric occurrence[ 61 ]. Although RFA is associated with lower grade 3 morbidity and shorter hospital stay, repeated hepatic resection resulted in a longer median recurrence-free survival vs RFA (23.6 mo vs 15.2 mo) in patients with recurrent HCC[ 62 ].…”