Abstract
Treatment options for recurrence of hepatocellular carcinoma after surgical resection: review of the literature and current recommendations for management
Highlights
Hepatocellular carcinoma (HCC) is the third most common cause of cancer related death worldwide[1] and its incidence in Western countries has increased by 75% in the last three decades[2]
We reviewed the literature on treatment for recurrent HCC (rHCC) and propose our personal strategy based on the available evidence
A recent meta-analysis showed that laparoscopic liver resection (LLR) for rHCC offered a benefit in terms of lower in-hospital complication rates, blood loss and a shorter hospital stay compared to open resection, similar 90-day mortality was observed between the two groups[45]
Summary
Hepatocellular carcinoma (HCC) is the third most common cause of cancer related death worldwide[1] and its incidence in Western countries has increased by 75% in the last three decades[2]. A recent meta-analysis showed that LLR for rHCC offered a benefit in terms of lower in-hospital complication rates, blood loss and a shorter hospital stay compared to open resection, similar 90-day mortality was observed between the two groups[45] This could be partially explained by the fact that, unlike conventional laparotomy, the laparoscopic approach does not require a wide surgical field, minimizing the freeing of adhesions and bleeding as well as other intraoperative complications. A median survival of 30 months and a 3-year survival of 29% has been reported in the treatment of primary HCC with TACE[60,61]; outcomes reported for rHCC are arguably poorer[26] This interventional radiology procedure should be offered to patients who are not candidates for surgical resection, SLT or RFA. On the contrary, when no clinical benefit is expected from chemotherapy, the management of end-stage rHCC is symptomatic and only supportive care should be offered[68]
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