Surgical treatment of recurrent hepatocellular carcinoma

During the last 16 years, radical resection was performed in 392 patients with hepatocellular carcinoma (HCC). Eight patients died within 30 days after resection. The other 384 patients were discharged from hospital and closely followed for 6 to 195 months. By December 1991, 185 patients had developed a recurrent tumor, the 1-, 3-, and 5-year recurrence rates being 15.0%, 45.4%, and 55.3%, respectively. Ninety of the 185 patients underwent reoperation, including second hepatic resection (65 cases), cryosurgery (8 cases), resection of lung metastasis (6 cases), hepatic artery ligation and infusion chemotherapy (2 cases), intratumor ethanol injection (3 cases), microwave coagulation plus intratumor ethanol injection (2 cases), and exploration (4 cases). The survival rate of these 90 patients was significantly better than that of 95 patients who were treated by other palliative methods, the 5-year survival rate being 63.4% as compared with 28.6% after the first resection (P < 0.01), and 40.8% vs. 2.2% after recurrence (P < 0.01), respectively. These results suggest that reoperation for recurrent HCC might be an important approach to prolonging survival further after hepatic resection.