Recurrence of hepatocellular carcinoma in the liver remnant after hepatic resection

doi:10.1016/S0002-9610(05)80972-9

The American Journal of Surgery

Volume 166, Issue 3, September 1993, Pages 270-273

https://doi.org/10.1016/S0002-9610(05)80972-9 Get rights and content

We analyzed the results of 19 patients who had intrahepaticrecurrence of hepatocellular carcinoma (HCC) among 47 patients who were discharged from the hospital after having a hepatic resection in order to evaluate the factors affecting recurrence and survival. Recurrence-free survival rates were 80%, 44%, and 28% at 1, 3, and 5 years, respectively. Of the 19 patients with recurrence, 14 had multiple lesions, and 16 of the recurrences were detected within 3 years of surgery. None of the following factors correlated with recurrence: hepatic function; tumor size; presence of tumor capsule; capsular invasion; vascular invasion and intrahepatic metastasis; extent of hepatic resection; and resection with tumor-free margins. Patients having multiple recurrent HCCs, however, had larger-sized tumors at the time of resection than those with a solitary recurrence. The survival rates after recurrence were significantly better in patients with a solitary recurrence, and these patients were treated with transcathter arterial embolization (TAE) therapy. Early detection as well as TAE for recurrent HCCs is necessary to improve long-term survival.

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Cited by (52)

Prognostic factors after liver resection for hepatocellular carcinoma with hepatitis B virus-related cirrhosis: The surgeon's role in survival
2009, European Journal of Surgical Oncology
Citation Excerpt :
Some authors advocated a definite resection margin of over 1 cm and found that this could definitely prolong the overall survival of patients.21–25 However, consistent with our study, other authors found no significant contribution of the surgical margin to tumor recurrence and the survival of patients.12,13,26–28 Since HCC primarily spreads through intrahepatic portal venous branches or hepatic venous tributaries, it seems reasonable that anatomic resection eradicates potential venous tumor thrombi in the anatomic region.
Little is known in judging significant factors that affect the outcome of hepatocellular carcinoma (HCC) patients with hepatitis B virus (HBV)-related cirrhosis undergoing liver resection. The aim of the present study is to investigate the controllable and uncontrollable poor prognostic factors for hepatectomy in patients with HBV-related cirrhosis.
Clinical and pathological data of 412 HCC patients with HBV-related cirrhosis undergoing liver resection from October 1996 to October 2006 were retrospectively reviewed and the prognostic risk factors were analyzed by univariate and multivariate analyses. Cumulative survival was calculated with respect to the number of prognostic risk factors.
The significant risk factors for decreasing both the overall and disease-free survival of patients were: (1) ascites volume of more than 500 ml; (2) prothrombin time of more than 4 s; (3) serum AFP of more than 400 ng/ml; (4) tumor distribution in two lobes; (5) vascular invasion; (6) capsule absence; and (7) blood transfusion of more than 600 ml. Moreover, female gender and operation time of more than 5 h are risk factors of tumor recurrence but not for the patients' overall survival. The 3-year survival rate decreased from 100% to 0 as the number of risk factors in the patients increased from zero to four or more. Patients who had two or more preoperative risk factors were poor candidates for liver resection, with a 3-year survival rate of 8.5%.
The survival of HCC patients with HBV-related cirrhosis after liver resection depends on preoperative liver reserve, tumor status and blood transfusion. Tumor status cannot be altered; however, the surgeon can do a great favor to the prognosis of patients by minimizing bleeding and blood transfusion. Patients with two or more preoperative risk factors should be cautiously selected for liver resection.
Tumor doubling time predicts recurrence after surgery and describes the histological pattern of hepatocellular carcinoma on cirrhosis
2005, Journal of Hepatology
Citation Excerpt :
Hepatocellular carcinoma (HCC) is the most frequent hepatic neoplasm; its association with chronic liver disease makes the treatment particularly problematic with many options being proposed, depending on the features of the tumor and the underlying liver disease, which vary from percutaneous alcohol injection or radiofrequency ablation to transplantation [1,2]. Surgical resection is considered the treatment of choice for HCC on compensated chronic liver disease, but a significant recurrence rate is expected [1,2]; factors such as the size and number of tumors, capsule presence, microscopic vascular invasion, histological grading, pathologic tumor-node-metastases (pTNM) stage and portal vein invasion have been demonstrated to influence recurrence after surgery [3–9]. Unfortunately, the majority of these prognostic factors in particular microscopic vascular invasion, node invasion and complete histological evaluation of tumor grading (including the worst area of differentiation often not revealed by biopsy) are strictly related to the pathological features of the tumor assessable only after surgery has been performed, and therefore of little help in selecting the best treatment.
Recurrence of hepatocellular carcinoma (HCC) following surgical resection is influenced by parameters detectable on the resection specimen or through a biopsy. The prognostic significance of HCC doubling time (DT) after surgery has never been investigated.
We evaluated 62 patients who underwent curative resection of a single HCC on cirrhosis; tumors were assessed before surgery on two subsequent occasions with the same imaging technique allowing the calculation of DT. The influence of tumor DT, clinical and pathological parameters on recurrence-rate and patients survival was assessed with uni- and multivariate analysis. Relationship between DT and pathological features was also analyzed.
Three-year recurrence rate was 32.3% (20 patients): this was significantly higher in the presence of DT shorter than 100 days (58 versus 18% when equal to or longer; P=0.008), microvascular invasion (59 versus 17% when absent; P=0.008) or tumor undifferentiation (54 versus 25% when well/moderately differentiated; P=0.015). DT was the only independent predictor of recurrence (P=0.005). Patients survival was affected by Child-Pugh class only. DT was significantly shorter in tumors with microvascular invasion (P=0.007), undifferentiation (P=0.003) and high alpha-fetoprotein levels (P=0.011).
DT is easy to estimate and indicates the prognosis of single HCCs prior to liver resection.
Indications of partial hepatectomy for transplantable hepatocellular carcinoma with compensated cirrhosis
2005, American Journal of Surgery
Citation Excerpt :
We treated HCC patients by partial hepatectomy while keeping a sufficient margin of more than 1 cm as far as possible. Consequently, we failed to secure a 5-mm margin histologically in half of our patients owing to unexpected tumor extension microscopically or undesirable tumor location [22–24]. When a tumor is located near the large glissons or hepatic veins, major hepatectomy must be performed to secure a sufficient surgical margin.
The appropriate treatment strategy for transplantable hepatocellular carcinoma (HCC) patients with compensated cirrhosis remains controversial.
Surgical outcomes were reviewed in 136 cirrhotic patients with transplantable HCC who had undergone partial hepatectomy. Transplantable HCC was defined as that corresponding to Milan’s criteria.
The adverse prognostic factors for both survival and disease-free survival were histologic surgical margin of 5 mm or less, Child-Pugh B, and the presence of hepatitis C virus infection. The overall 5-year survival and disease-free survival rates of patients with 1 or none of the adverse prognostic factors were 73% and 33%, respectively, whereas those of patients with 2 or 3 adverse prognostic factors were 36% and 17%, respectively.
Transplantable HCC patients with 2 or 3 adverse prognostic factors should be considered candidates for liver transplantation, whereas patients with only 1 or none of the adverse prognostic factors are good candidates for partial hepatectomy.
Hepatocellular carcinoma: Surgical indications and results
2003, Critical Reviews in Oncology/Hematology
Hepatocellular carcinoma (HCC) is a tumour of increasing incidence that usually arises in cirrhotic liver. Untreated, the prognosis is grim and the only curative treatment is surgical resection. The practical application of segmental surgery to the liver together with the use of ultrasound and other imaging techniques, patient selection criteria and improvements in perioperative technique and postoperative care have contributed to better results in hepatic surgery. Today, less than 10% mortality for resection of cirrhotic livers, with up to 50% 5-year survival rates are to be expected. However, the limits of resection for cure: intrahepatic recurrence makes stringent follow-up necessary. In this way the available modalities of treatment can be applied so as to improve survival. Herein, a current “state-of-the-art” of surgical indications and results for HCC is given.
Hepatocellular carcinoma: Current surgical management
2001, Seminars in Oncology
At present the only potentially curative treatment for hepatocellular carcinoma (HCC) is either partial hepatectomy or total hepatectomy with orthotopic liver transplantation (OLT). Underlying liver reserve and regenerative capacity are the most important determinants of the risk of postoperative hepatic failure after partial hepatectomy; thus, careful preoperative assessment of liver function is mandatory. In specialized centers perioperative mortality is less than 5%, although cirrhotic patients are at increased risk. Various neoadjuvant and adjuvant therapies are under investigation, but as yet there are no data that demonstrate benefit from adjuvant systemic chemotherapy. The use of OLT is limited by the difficulty of obtaining donor livers. Patients selected for transplantation and partial hepatectomy represent two distinct subgroups, but their survival after treatment is comparable. Despite the progress in the management of HCC by surgical resection, the fact remains that the majority of these patients will experience local recurrences. This has led to the development of a variety of novel new treatments that require further evaluation.
Does the margin width influence recurrence rate in liver surgery for hepatocellular carcinoma smaller than 5 cm?
2017, European Review for Medical and Pharmacological Sciences

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¹: From the First Department of Surgery, Tohoku University School ofMedicine, Sendai, Japan.

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Recurrence of hepatocellular carcinoma in the liver remnant after hepatic resection

Hepatocellular carcinoma: a clinical and pathologic analysis of 57 hepatectomy cases

Cancer

Results of surgical treatments of primary hepatocellular carcinoma: some aspects to improve long-term survival

World J Surg

Hepatic resection for hepatocellular carcinoma associated with liver cirrhosis

World J Surg

Limited hepatic resection effective for selected cirrhotic patients with primary liver cancer

Ann Surg

Prognostic histologic features of resected small hepatocellular carcinoma (HCC) in Taiwan: a comparison with resected large HCC

Cancer

Hepatic resection for hepatocellular carcinoma: clinical features and long-term prognosis

Ann Surg

Therapeutic effects for recurrence after resection of hepatocellular carcinoma

Jpn J Gastroenterol Surg