Indications for, and effectiveness of, a second hepatic resection for recurrent hepatocellular carcinoma

Second hepatic resection (SHR) for recurrent hepatocellular carcinoma (HCC) appears to have a better prognosis than other treatments; however, it is not clear whether this is the result of the procedure, or of the underlying condition of patients undergoing this treatment.

Consecutive hepatic resection for 13 years, many patients suffered from recurrence in the remnant liver. After detection of recurrence, these lesions were treated in various ways including SHR. In this communication, recurrent patients were divided into SHR patients and non-SHR patients. In these two groups, we analyzed clinicopathologically.

After 341 curative hepatic resections for HCC, recurrences presented in 193 patients (57%). SHR was performed in 31 patients (16%), while the other 162 patients (84%) underwent other treatments. At first resection, the group did not significantly differ in sex, age, evidence of hepatitis infection, liver function tests, tumor size, presence of portal vein invasion and evidence of histologic cirrhosis. SHR patients had more tumor-free days following first resection than non-SHR patients (p < 0.05). The survival rate following recurrence for SHR patients was better than that of non-SHR patients (p < 0.05). Among the non-SHR patients, 23 patients met criteria for the procedure. Survival rate for the 31 SHR patients also was better than that of these 23 patients (p < 0.05).

Since SHR is safe, effective, and offers an improved prognosis for recurrent HCC, it should be the treatment of choice whenever possible.