Hepatectomy For Recurrent Hepatocellular Carcinoma Research Articles

The Feasibility of Third or More Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma.

To investigate the feasibility and prognostic benefits of third or more hepatectomy (third or more Hx) for recurrent hepatocellular carcinoma. Second hepatectomy (second Hx) has been accepted as an effective treatment of recurrent hepatocellular carcinoma after first hepatectomy (first Hx). However, the feasibility and efficacy of third or more Hx have not been adequately assessed. Data were reviewed from 1340 patients with hepatocellular carcinoma who underwent curative hepatectomy. Among them, 941, 289, and 110 underwent first Hx, second Hx, and third or more Hx, respectively. Surgical outcomes and long-term survival were compared among the groups. Surgical duration was significantly longer in third or more Hx (median, 6.4 hours) than in second Hx (median, 5.9 hours). Postoperative bile leakage and wound infection were more frequently observed in third or more Hx versus second Hx (12.5% vs 6.2%, [P = 0.04] and 2.9% vs 0.4% [P = 0.03], respectively). Three and 5-year disease-free survival rates were 36.8% and 27.1% in first Hx, 24.4% and 17.9 % in second Hx, and 26.1% and 12.8% in third or more Hx, respectively (P < 0.01 [first Hx vs third Hx], P = 0.95 [second Hx vs third or more Hx]). The 5-year overall survival rates from each resection were similar among the groups (65.3%, 60.5%, 68.2%, respectively). The 5- and 10-year overall survival rates from initial hepatectomy in patients who received third or more Hx were 91.4% and 75.5%, respectively. Third or more Hx is technically demanding in terms of surgical duration and morbidity compared with second Hx. However, aggressive repeat resection offers a survival similar to second Hx, leading to cumulative long-term survival from initial resection.

Laparoscopic hepatectomy for recurrent hepatocellular carcinoma after previous open hepatectomy

To evaluate the feasibility, safety and long-term outcomes of laparoscopic repeat hepatectomy for recurrent hepatocellular carcinoma (HCC) following previous resection. Between January 2003 and January 2011, 14 patients with recurrent HCC were carefully selected to undergo repeat laparoscopic hepatectomy, among which 9 patients were male, 5 patients were female, and the average age was 54 years. Prior to re-resection, all patients had undergone at least one open hepatectomy for HCC. The perioperative and long-term outcomes of these patients were retrospectively analyzed. Repeat laparoscopic hepatectomy for these 14 patients were successfully performed without major perioperative complications. The mean operative time, intraoperative blood loss and hospital stay were (124 ± 82) minutes, (112 ± 43) ml and (7 ± 4) days, respectively. The mean follow-up period was 23 months (range 14 to 42 months). At the time of follow-up, 11 patients were still alive, among which 3 patients developed recurrent disease and 8 patients remained disease free. One patient died of liver dysfunction at 21 months, and another 2 patients died of tumor recurrence at 17, 31 months, respectively. Laparoscopic surgery for recurrent HCC remains a viable option for repeat hepatectomy in selected patients who have undergone open hepatectomy.

Third or more repeat hepatectomy for recurrent hepatocellular carcinoma

We sought to evaluate the surgical results of third or more repeat hepatectomy for recurrent hepatocellular carcinoma (HCC). The role of repeat hepatectomy for recurrent HCC, especially in cases with third or more repeat hepatectomy, is controversial. We performed A retrospective, cohort study to analyze the surgical results of repeat hepatectomy performed at a single medical center from 1989 to 2011. A total of 1,000 hepatectomies for HCC were divided into 3 groups: A first hepatectomy group (n = 791), second hepatectomy group (n = 163), and third or more hepatectomy group (n = 46). Operative results and patient prognoses were compared among the 3 groups. There were no differences in early surgical results such as mortality and morbidity among the 3groups. The 5-year survival rates after the first, second, and third or more hepatectomy were 67%, 60%, and 43%, respectively (P = .1913). There was a significant difference in disease-free survival among the 3 groups, and the 5-year disease-free survival rates after first, second, and third or more hepatectomy were 37%, 29%, and 18%, respectively (P = .0169). Third or more repeat hepatectomy for recurrent HCC was performed safely and associated with relatively long-term survival. Third or more repeat hepatectomy for recurrent HCC seems justified, but high rate of HCC recurrence remains a problem.

Repeat Hepatectomy for Recurrent Liver Metastasis From Gastric Carcinoma

The efficacy of repeat hepatectomy for recurrent hepatocellular carcinoma and colorectal liver metastases is widely accepted. However, the benefits of such treatment for intrahepatic recurrence of gastric cancer liver metastasis remain unknown. This study sought to clarify the survival benefit for patients undergoing repeat hepatectomy for gastric cancer liver metastasis. A total of 73 patients underwent hepatectomy for gastric cancer liver metastasis from January 1993 to January 2011. Macroscopically curative surgery was performed in 64 patients. Among them, repeat hepatectomy was performed in 14 of the 37 patients with intrahepatic recurrence. Among these 14 patients, clinicopathologic factors were evaluated by univariate and multivariate analysis to identify the factors affecting survival. The overall 1-, 3-, and 5-year survival rates after a second hepatectomy were 71, 47, and 47 %, respectively. The median survival was 31 months. Operative morbidity and mortality rates of repeat hepatectomy were 29 and 0 %, respectively. Multivariate analysis identified the duration of the disease-free interval as the only independent significant factor predicting better survival. In selected patients, repeat hepatectomy for recurrent gastric cancer liver metastasis may offer the same chance of cure as the primary hepatectomy. Disease-free intervals exceeding 12 months predict good patient survival after repeat hepatectomy.

Tu1061 Impact of Multiple Tumors or Portal Hypertension on the Results of Second Hepatectomy for Recurrent Hepatocellular Carcinoma: A Single Center Experience

Background & Aims: Roayaie et al. reported a 5-year overall survival (OS) rate of 67% after second hepatectomy for recurrent hepatocellular carcinoma (HCC) in highly selected patients with a single nodule, preserved liver function, and noportal hypertension (PHT). The aim of this study was whether second liver resection can offer survival benefit for patients with multiple HCCs and/or PHT. Methods: We retrospectively studied 101 patients who had undergone second liver resection for recurrent HCC and stratified them into 3 groups according to the number of tumors and the presence of PHT, defined as a platelet count , 100,000/μL and/or the presence of esophageal varices: group A, patients with solitary tumor and no-PHT (n = 45); group B, those with either multiple tumor or PHT (n = 48); and Group C, those with both multiple tumor and PHT (n = 8). Overall survival (OS) and recurrence rate (RR) curves were constructed by the Kaplan-Meier method, and multivariate regression analysis was performed using the Cox proportional hazard model. Results: There was no 30-day mortality. The morbidity rate was comparable among the groups. The 5year OS rates and the 2-year recurrent rates were 67% and 60% in group A, 62%and 55% in group B, and 38% and 88% in group C, respectively, showing no significant differences among the three groups. In a multivariate analysis, neither multiple tumors nor presence of PHT was a predictive factor for poor prognosis. Conclusions: We can extend the indication of second hepatectomy for recurrent HCC, at least, to the patients with either multiple HCCs or PHT.

Poor Prognostic Factors after Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma in the Modern Era

The purpose of this study was to determine the poor prognostic factors after repeat hepatectomy (Hx) in patients with recurrent hepatocellular carcinoma (HCC). Overall survival rates and clinicopathological variables in 112 patients with repeat Hx from 1992 to 2010 were compared with those in 531 patients who underwent a primary Hx. To clarify the poor prognosis factors after repeat Hx, survival data among 112 patients were univariately and multivariately analyzed. Overall survival after repeat Hx was similar for that of the patients who underwent a primary Hx. The mean age of repeat Hx group was significantly higher, and a well-preserved liver function was recognized than the primary Hx group. Multivariate analysis revealed that: 1) indocyanine green retention rate at 15 minutes; 2) disease-free interval; 3) tumor size; 4) portal vein invasion at primary Hx; 5) gender; and 6) estimated blood loss to be an independent and significant poor prognostic factors. The overall 3-year postrecurrence overall survival rates were 100, 91.3, 59.6, and 0 per cent at risk number (R) R0, R1/2, R3, R4, respectively (P < 0.05). Repeat Hx provided a good compatible prognosis with primary Hx. In our findings, five risk factors to predict poor outcomes after repeat Hx were useful. Patients with recurrent HCC do not have universally poor outcomes, and our simple scoring system using five poor prognostic factors could serve to advise the prognosis and the potential benefit for patient selection about repeat Hx.

Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma: retrospective randomized control study

ObjectivePercutaneous radiofrequency ablation (PRFA) is known to be as effective as hepatectomy for small hepatocellular carcinoma (HCC) in the long-term. We wished to ascertain how it is for recurrent small HCC. MethodsFrom January 2009 to November 2011, a series of sixty-one patients were included in the study according to the criteria: each patient had one recurrent HCC, less than 5 cm in diameter. Twenty-six of the 61 patients were treated with PRFA and the other 35 were treated with repeat hepatectomy. ResultsThe interval from first surgery to recurrent for repeat hepatectomy and PRFA groups were (1,239.60±1,017.00) d and (903.42±975.11) d respectively (P=0.066). The tumor-free time after repeat hepatectomy and PRFA were (310.23±159.50) d and (278.27±123.29) d respectively (P=0.584). Size of tumor in repeat hepatectomy and PRFA were (7.34±3.16) cm2 and (5.59±3.40) cm2 (P=0.215), the total expenditure for each patient of the two groups were (26,150.66±7,923.60) yuan and (21,135.00±1,156.76) yuan (RMB), and the time of hospitalization for each of the two groups were (15.29±4.28) d and (7.46±2.20) d (P<0.001). ConclusionPRFA is proved to be as effective as repeat hepatectomy in the treatment of recurrent small HCC, and superior to repeat hepatectomy as it is less invasive.

PA1 PRIMARY HEPATOCELLULAR CARCINOMA IN NON-CIRRHOTIC CHILDREN: FAVORABLE OUTCOME

Background: Primary neoplasms of the liver are rare in children, comprising only 1.1% of malignancies in younger than 20 years of age. Hepatoblastoma comprises over two-thirds of the malignant tumors of the liver in children and hepatocellular carcinoma (HCC) accounts for most of the remaining cases. In pediatric population, HCC is a very rare tumour and is traditionally linked to liver chirrosis and to ongoing process of liver necrosis/regeneration (viral hepatitis or metabolic disease) but could also be observed in a non-chirrotic liver. In contrast to the age-incidence relationship for hepatoblastoma, the incidence of HCC increased with each successive 5-year age group. We report our single center experience with 3 patients with HCC in non-chirrotic liver and their therapeutic management. Methods: The medical records of 3 male children, with median age of 9 years (range, 8–10) who presented, with primary hepatocellular carcinoma on non –chirrotic liver, at our centre were reviewed. Ultrasonography, computed tomographic (CT) scan, and needle biopsy were the initial methods used to diagnose malignant tumors. The following data were analyzed: age at diagnosis, treatment modalities, histopathologic findings, surgical details, operative complications, and treatment results. Data related to surgery included the extent of the hepatic resection, macroscopic margins, and operative complications. When the tumor was considered unresectable by the postchemotherapy CT scan, transplantation was considered. Before that could occur, the patient underwent extensive scanning to assess for distant metastases. Treatment results were evaluated by the occurrence of local or distant recurrence and duration of survival. Results: In all patients clinical symptoms were history of fever, abdominal pain, and hepatosplenomegaly. Their serum α-fetoprotein level at presentation was markedly raised, with median value of 41142 ng/mL (range 1266070768). Hepatic biopsy was performed under sonographic guidance, and the diagnosis of HCC was made. In 1 case the extent of disease, limited to the liver, lead to tumour resection with hepatectomy, nevertheless 2 years later he underwent to repeated resection for primary liver tumor recurrence. Actually he is in well clinical condition, his serum α-fetoprotein is in the normal range and the radiological assessment show the absence of distant metastases. In 2 cases chemotherapy treatment was started according to the protocols of SIOPEL V, but the tumor did not respond to allow a resection. This fact, along with the absence of distant metastases on whole-body CT, suggested liver transplantation as a possible therapeutic option. The patients underwent surgical resection en bloc of the native liver and received a whole liver transplant. Immunosuppression with Tacrolimus was started first days after surgery. The serum α-fetoprotein level after transplantation fell down reaching normal values in 1 month for both patients (median value 9.5 ng/mL, range 9-10 ng/mL). Our 2 patients received tacrolimus as primary component of their post-OLT immunosuppression, adding SRL at least 1 month after transplantation to reduce the risk of delayed wound healing or incisional hernia due to the property of mTor inhibitor. Both transplanted patients recieved 1 year neoadiuvant therapy post OLTx. Contrast-enhanced CT of the transplanted liver was performed once a year: no lesion was seen in the liver parenchyma and the absence of liver metastasis was confirmed. In their 2 years follow-up survival and event free survival were comparable even better between this group and all patients who underwent OLTx for all the other indications. Discussion: Non-resectable forms of intrahepatic recurrence may, in the absence of extrahepatic spread, benefit from liver transplantation. This attitude may broaden the curative possibilities. Recurrence of hepatocellular carcinoma after liver transplantation is common (30% in adults), and the prognosis is not favorable. We try to avoid possible recurrence drawing a specific immunosuppression regimen. Experience with sirolimus (SRL)-based immunosuppression following OLT is rapidly accumulating. In different models, mTOR inhibitors (mTORIs) were effective in reducing cell growth and tumor vascularity. In combination with calcineurin inhibitors, SRL may reduce the incidence of acute rejection and lower overall required drug levels. Different studies indicate that sirolimus might be a promising drug for this treatment, but further clinical studies elucidating the biological effects are advocated to reach further improvement in the management of advanced disease. Repeat resection for primary liver tumor recurrence is feasible in patients with recurrence limited to the liver and good liver function. A survival at 5 years of 59% similar to that after the first hepatectomy, suggests a benefit from a hepatectomy for recurrent HCC.

Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review

BackgroundThis study aimed to assess the efficacy and safety of repeat hepatectomy for recurrent hepatocellular carcinoma (HCC).MethodsThirty-seven patients who underwent a curative repeat hepatectomy in our hospital were retrospectively studied. An extensive database literature search was performed to obtain for all relevant studies.ResultsIn our series, there were no perioperative deaths during repeat hepatectomy for recurrent HCC. Patients survival after repeat hepatectomy were similar to 429 patients undergoing initial hepatectomy. A computerized search of the Medline and PubMed databases found 29 retrospective studies providing relevant data in 1149 patients were included for appraisal and data extraction. After the repeat hepatectomy, postoperative morbidity ranged from 6.2% to 68.2% with a median per cohort of 23.5 per cent. There were 7 perioperative deaths (0.7 per cent of 993 for whom mortality data were provided). The overall median survival ranged from 21 to 61.5 months, with 1 -, 3 -, and 5-year survival of 69.0% to 100%, 21.0% to 87.0%, and 25.0% to 87.0%, respectively.ConclusionsRepeat hepatectomy can be performed safely and is associated with long-term survival in a subset of patients with recurrent HCC. However, the findings have to be carefully interpreted due to the lower level of evidence. A randomized controlled study is needed to compare repeat hepatectomy and other modalities for recurrent HCC.

A case of laparoscopic hepatectomy for recurrent hepatocellular carcinoma

Conventional hepatectomy is an effective way to treat hepatocellular carcinoma. However, it is invasive and stressful. The use of laparoscopy in hepatectomy, while technically demanding, reduces surgical invasiveness and stressfulness but still achieves complete resection with adequate margins. Compared with conventional hepatectomy, laparoscopic hepatectomy provides a better chance and situation for further surgery in the case of recurrence of hepatocellular carcinoma. Even aged patients can successfully endure repeated hepatectomy using laparoscopy, as shown in the present report. This report presents a case of repeated laparoscopic hepatectomy treating hepatocellular carcinoma and its recurrence in an aged patient having cirrhosis, a disease causing extra difficulty for performing laparoscopic hepatectomy. The report also describes techniques of the operation and displays characteristic results of laparoscopic hepatectomy such as smaller wounds, less blood loss, less pain, less scars and adhesion, shorter postoperative hospital stay, and faster recovery.

Repeat hepatectomy for recurrent hepatocellular carcinoma

Long-term prognosis of patients with hepatocellular carcinoma (HCC) after partial hepatectomy remains unsatisfactory because of the high incidence of recurrence in the liver remnant. Controversy exists about the efficacy of repeat hepatectomy for recurrent HCC patients. The purpose of this study was to retrospectively examine and clarify the significance of repeat hepatectomy in the treatment of recurrent HCC. From January 1990 to December 2004, 84 patients with recurrent HCC underwent a second hepatectomy with curative intent. Survival rates in these 84 patients were analyzed retrospectively. After the second hepatectomy, the overall 5-year survival rate was 50% for the 84 patients included in this study; the corresponding recurrence-free survival rate was 10%. Multivariate analysis showed that the second hepatectomy performed between 1997 and 2004 (P < .001) and the absence of microscopic vascular invasion at the second hepatectomy (P = .001) were the significant and independent prognostic factors for overall survival after the second hepatectomy. The overall 5-year survival rate after the second hepatectomy was 80% in 46 patients who had both these prognostic factors. However, even in the subgroup with good long-term survival, the 5-year recurrence-free survival rate was only 6%. The more times hepatectomy was repeated, the shorter the recurrence-free interval became. Repeat hepatectomy for recurrent HCC had survival benefits, especially for patients without microscopic vascular invasion. However, the incidence of re-recurrence after the second hepatectomy was high, and the recurrence-free interval was short, even in the subgroup with survival benefits. The effectiveness of repeat hepatectomy for curing recurrent HCC is limited.

Repeat hepatectomy for recurrent hepatocellular carcinoma.

This study evaluated the results of repeat hepatectomy for recurrent hepatocellular carcinoma (HCC) and delineated the limitations of such a treatment strategy. Of 290 patients who had radical hepatic resection, 167 had intrahepatic tumour recurrence. Fifty patients underwent a second hepatectomy. Third and fourth hepatectomies were carried out on six and two patients respectively. There were 36 men and 14 women. Age ranged from 32 to 77 years (mean 59.1 years). Liver cirrhosis was present in 38 and chronic hepatitis in 12 patients. Operative death occurred in four patients (8 per cent) after a second and in one of six after a third hepatectomy, compared with 4.5 per cent after first hepatectomy. The five postoperative deaths were attributed to either Child grade B or C liver disease, or severe intraoperative bleeding. The 5-year survival rate was better in these 50 patients (41 per cent) than in 117 patients who were treated otherwise (7 per cent). The present study indicates that repeat hepatectomy may be useful for recurrent HCC. It is indicated principally for patients with a solitary tumour and Child grade A liver disease.

Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma

Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma

Surgical resection for recurrent hepatocellular carcinoma: Prognosis and analysis of risk factors

Hepatocellular carcinoma (HCC) is common in Asian countries, and tumor recurrence is the most common cause of treatment failure after curative resection. Repeated hepatectomy is performed only for selected patients because most patients with HCC also have liver cirrhosis and poor liver function reserve. The purposes of this study were to clarify the outcome of the patients after second hepatectomy for recurrent HCC and to evaluate the prognostic factors after second hepatectomy. We used retrospective cohort study to examine the disease-free survival, cumulative survival, and possible prognostic factors for recurrence and death in 59 patients who underwent surgical resection for recurrent HCC at the National Taiwan University Hospital from August 1986 to December 1993. Another 64 patients with unresectable recurrent HCC were used as a historical control group. The survival curves between those patients with resectable HCC and those with unresectable HCC were compared. After resection for recurrent HCC, gender and multiplicity (n > 3) of tumor affect recurrence rate (p = 0.046 and 0.021, respectively), whereas gender, age, and tumor invasiveness affect survival rate significantly (p = 0.024, 0.021, and 0.046, respectively). The survival rate of patients with resectable HCC was significantly better than that of those with unresectable HCC. For recurrent HCC surgical resection is an effective mode of treatment in selected patients. Whether surgery is better than other modes of treatment in the treatment of resectable recurrent HCC demands further investigation.

P-524 Indication and limitation of repeat hepatectomy for recurrent hepatocellular carcinoma

P-524 Indication and limitation of repeat hepatectomy for recurrent hepatocellular carcinoma