Clinical management of recurrent hepatocellular carcinoma after primary resection

Curative resections were performed on 121 patients with primary hepatocellular carcinoma from 1975 to 1986 at Kyushu University Hospital, Japan. Up to August 1987 there was a recurrence in 41, detected between 4 and 86 (mean 20) months after surgery. Intrahepatic recurrences were the most common (82 per cent). There was no statistically significant correlation between size of the primary tumour and interval from surgery to detection of recurrence (r = -0.09). Serial measurement of serum alpha-fetoprotein (AFP) was useful for the detection of recurrences. However, the levels of AFP seem to be a non-specific, unreliable test for such patients since this tumour marker showed different ranges before the primary surgery and at the time of recurrence in 5 of the 41 patients (12 per cent). Postoperative chemotherapy with oral 5-fluorouracil had no apparent preventative effect on the recurrence. A second curative resection was effective in four patients, and three survived for over 2 years; the longest survival time is 9 years after the second procedure.