Appropriate treatment strategy for intrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma

Fumitoshi Hirokawa, Michihiro Hayashi, Yoshiharu Miyamoto, Mitsuhiro Asakuma, Tetsunosuke Shimizu, Koji Komeda, Yoshihiro Inoue, Nobuhiko Tanigawa
Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2011, 15 (7): 1182-7

INTRODUCTION: The aim of this study is to evaluate the appropriate treatment for intrahepatic recurrence after hepatectomy for hepatocellular carcinoma (HCC).

METHODS: Of 151 patients who underwent initial hepatectomy for HCC, 82 had intrahepatic recurrence and were divided into two groups: group A, ≤2 tumors, each 3 cm in size; and group B, beyond the group A. Survival and treatment in each group were analyzed retrospectively to determine the best therapeutic modality for intrahepatic recurrence.

RESULTS: The 5-year overall survival and recurrence rate were 65% and 58%, respectively. Overall 1-, 3-, and 5-year survival rates after recurrence were better in group A (100%, 76%, and 54%) than in group B (74%, 23%, and 5.8%; p < 0.001). The clinical backgrounds were not different for each modality. Of the 43 patients in group A, 10 underwent hepatectomy, 21 ablation therapy, and 12 transcatheter arterial chemoembolization (TACE). The survival rate of hepatectomy was similar to that of ablation therapy and significantly better than that of TACE (p = 0.0248). Of the 39 patients in group B, the results of TACE were similar to other therapies after recurrence.

CONCLUSIONS: Repeat hepatectomy and ablation therapy were more effective than TACE in the group with ≤2 tumors up to 3 cm in size at recurrence, while any treatment modality was more effective than best supportive care, but the outcome was poorer in the group with ≥3 tumors or tumor size ≥3 cm at recurrence.

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