Efficacy of repeat hepatic resection for recurrent hepatocellular carcinomas

Yasuhiko Nagano, Hiroshi Shimada, Michio Ueda, Kenichi Matsuo, Kuniya Tanaka, Itaru Endo, Chikara Kunisaki, Shinji Togo
ANZ Journal of Surgery 2009, 79 (10): 729-33

BACKGROUND: This study evaluated the efficacy of repeat hepatic resection for recurrent hepatocellular carcinoma (HCC) and the clinicopathological factors influencing overall survival after resection.

METHODS: From 1992 to 2005, 231 patients underwent curative hepatic resection for HCC at Yokohama City University, Japan. Of these, 105 patients developed intrahepatic recurrence, and 24 repeat hepatectomies were performed for recurrent HCC. Survival data were analysed, and prognostic factors for repeat hepatic resection were determined.

RESULTS: The overall cumulative 1-, 3- and 5-year survival rates and the median survival time of the patients after initial hepatic resection (n= 231) did not differ from those of the patients after repeat hepatic resection (n= 24), with values of 91.3, 70.2 and 49.1%, and 57 months, versus 91.7, 73.1 and 50.9%, and 61.5 months, respectively (P= 0.875). The operative time and blood loss in patients who underwent repeat hepatic resection did not differ from those who underwent primary resection. Multivariate analysis identified portal invasion at the first hepatic resection and a disease-free interval of <or=1.5 years after primary hepatic resection as independent risk factors for survival after repeat hepatic resection. The 12 patients who did not show either of the two prognostic factors had 3- and 5-year survival rates of 91.7 and 68.8%, respectively, after repeat hepatic resection.

CONCLUSIONS: Our findings suggest repeat hepatic resection as the treatment of choice for recurrent HCC patients without portal invasion at the first resection whose recurrence develops after a disease-free interval of >1.5 years since the previous surgery.

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