Surgical management of recurrent liver tumors

Hepatic resection remains the only potentially curative treatment modality for patients with primary and secondary malignant hepatic tumors. Unfortunately, most patients undergoing resection will develop recurrent disease. Aggressive local treatment of recurrent disease should be considered for patients with recurrence limited to the liver after an initial "curative" hepatic resection. In these patients, repeat hepatic resection can be performed safely and may result in long-term DFS. The decision to perform a repeat hepatic resection must currently be based on the same guidelines as used in selecting a patient for an initial hepatic resection: a limited number of metastases, the technical ability to resect all gross disease, satisfactory general medical condition of the patient, and adequate functional hepatic reserve. Cryotherapy is presently the only alternative to resection that may offer patients with intrahepatic recurrence a chance for long-term disease control. Although many questions remain regarding the ultimate role of cryotherapy and because current technology limits the size of lesions that can be successfully treated, experience to date indicates that it may be comparable to resection for some patients. Combinations of resection, cryotherapy, and regional chemotherapy may expand the population of patients with recurrent hepatic disease that may be managed surgically. Further evaluation of these treatment modalities in clinical trials will establish their ultimate role in the management of recurrent primary and secondary hepatic malignancies.