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Rationale of surgical management for recurrent hepatocellular carcinoma
Insights
Aggressive surgical management of recurrent hepatocellular carcinoma (HCC) significantly improves patient survival. Repeated operations for HCC offer better long-term outcomes compared to conservative treatment.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) is a primary liver malignancy.
- Curative hepatic resection is a standard treatment for early-stage HCC.
- Recurrence after resection remains a significant challenge.
Observation:
- A study followed 100 patients with HCC who underwent curative hepatic resection.
- Intrahepatic recurrence was observed in 40% of 91 patients during follow-up.
- 22 patients with recurrent HCC underwent repeat surgical interventions.
Findings:
- Repeat operations for recurrent HCC, including re-extirpation or ethanol injection with infusion ports, were performed on 22 patients.
- 15 of these 22 patients survived for 13-92 months post-operation.
- Survival rates were significantly better in patients undergoing repeated operations versus conservative management (p < 0.05).
Implications:
- Aggressive surgical management of recurrent HCC is crucial for improving patient prognosis.
- Repeat surgical interventions can lead to long-term survival in selected HCC patients.
- Further research into optimal management strategies for recurrent HCC is warranted.
Abstract:
From 1979 to 1991, 100 patients with hepatocellular carcinoma (HCC) underwent a curative hepatic resection in our institution. Five patients died within 1 month, and four patients died after longer than 1 month hospitalization. The remaining 91 patients were closely followed. Intrahepatic recurrences became obvious in 36 (40%) of these 91 patients during the follow-up period. Second operation was carried out on 22 patients, and the re-extirpation of HCCs was performed on 16 patients. Pure ethanol injection into the tumor associated with implantation of the Infuse-A-Port (Infusaid Inc., Norwood, MA) for intra-arterial infusion of anti-cancer agents was performed on the remaining six patients. Of these 22 patients, 15 are still alive, eight being free of HCC and seven with the disease, for 13 to 92 months after the first operation. The cumulative survival rate of 22 patients with repeated operations was significantly better than that of 14 patients who were treated conservatively (p < 0.05). The adequate surgical management of recurrent HCC is considered as most important in achieving better prognosis of HCC.