Defining an optimal surgical strategy for treatment of recurrent hepatocellular carcinoma after hepatectomy: re-resection or radiofrequency ablation?

Abstract

BACKGROUND: Tumor recurrence after resection of hepatocellular carcinoma (HCC) is a common phenomenon with a 5-year recurrence rate over 50%. Aggressive salvage treatment policy in the form of re-resection or radiofrequency ablation (RFA) improves the prognosis of patients with recurrent disease. However, the choice of treatment to achieve better survival benefit in the management of recurrent HCC is not yet clear. METHODS: From January 2001 to December 2008, 179 patients developed intrahepatic recurrences after hepatectomy for HCC in our center. 29 patients received re-resections and 45 patients received RFA as salvage treatment. Patient characteristics, clinicopathological data, and survival outcomes were reviewed, and compared between the two groups. P value < 0.05 was considered to be significant. Results: Patients in the RFA group were older than those in the re-resection group (59 vs. 52-year-old). Nonetheless, the liver function status, staging of the initial tumor and time to develop first recurrence after hepatectomy for initial tumor (12.2 vs. 8.7 months, p = 0.84) were comparable between the two groups. There was no difference in recurrent tumor size (2.1 vs. 2.1 cm, p = 0.73) and tumor multi-focality. The time to develop further tumor recurrence after re-resection and RFA were 5.9 and 4.0 months (p = 0.30). The 1-, 3- and 5-year tumor-free survival rates after re-resection were 41.4, 24.2 and 24.2%, respectively, and after RFA were 32.2, 12.4 and 9.3% respectively (P = 0.14). The 1-, 3-, and 5-year overall survival rates after re-resection were 89.7, 56.5 and 35.2%, respectively, and after RFA were 83.7, 43.1 and 29.1%, respectively (P = 0.48). The 1-, 3- and 5-year overall survival rates after hepatectomy for initial tumor in the re-resection group were 89.7, 82.3 and 55.7%, and in the RFA group were 95.6, 68.2 and 44.5%, respectively. CONCLUSION: Both RFA and re-resection attain similar survival benefit in the management of recurrent HCC after hepatectomy.