Abstract
Background
The results of salvage hepatectomy for local recurrent hepatocellular carcinoma after incomplete percutaneous ablation therapy are still unclear.
Methods
We conducted a retrospective analysis of 197 consecutive patients with hepatocellular carcinoma who underwent either salvage hepatectomy after prior incomplete percutaneous ablation therapy (salvage group; n = 23) or primary hepatectomy as the initial treatment (primary group; n = 174). The two groups were compared with respect to intraoperative data, operative mortality and morbidity, and long-term survival.
Results
The salvage group showed a significantly longer operation time (385 vs. 300 min; P = 0.006) and a significantly greater intraoperative blood loss volume (402 vs. 265 ml; P = 0.024). The postoperative mortality rate was zero in both groups, and the morbidity rates were similar. Although the 1-, 3-, and 5-year disease-free survival rates after hepatectomy were significantly worse in the salvage group than in the primary group (65%, 41%, and 33% vs. 81%, 51%, and 45%, respectively; P = 0.031), the overall survival rates after hepatectomy did not differ significantly (91%, 91%, and 67% vs. 96%, 79%, and 65%, respectively; P = 0.790). The 1-, 3-, and 5-year overall survival and disease-free survival rates after percutaneous ablation therapy were also not different from those in the primary group (100, 96, and 83%, P = 0.115; and 96, 60, and 45%, P = 0.524, respectively).
Conclusions
The short-term and long-term results of salvage hepatectomy after incomplete percutaneous ablation therapy are equivalent to those of primary hepatectomy. Salvage hepatectomy is an acceptable treatment for patients with local recurrence of hepatocellular carcinoma after ablation therapy.
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References
Bouza C, López-Cuadrado T, Alcázar R, Saz-Parkinson Z, Amate JM. Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol. 2009;9:31.
Shiina S, Tagawa K, Nina Y, et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma in 146 patients. AJR Am J Roentgenol. 1993;160:1023–8.
Lencinoni RA, Allgaier HP, Cioin D, et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology. 2003;228:235–40.
Harrison LE, Koneru B, Baramipour P, et al. Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma. J Am Coll Surg. 2003;197:759–64.
Yin XY, Xie XY, Lu MD, et al. Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer. 2009;115:1914–23.
Ishizaki Y, Yoshimoto J, Sugo H, Miwa K, Kawasaki S. Hepatectomy using traditional Péan clamp-crushing technique under intermittent Pringle maneuver. Am J Surg. 2008;196:353–7.
Terminology Committee of the International Hepato-Pancreato-Biliary Association. The Brisbane 2000 terminology of liver anatomy and resections. HBP Surg. 2000;2:333–9.
Le CC. Foie: etudes anatomiques et chirugicales. Paris: Masson & Cie; 1957.
Liver Cancer Study Group of Japan. The general rules for the clinical and pathological study of primary liver cancer. 5th ed. Tokyo: Kanehara-Syuppan; 1989 (in Japanese).
Dido D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
N’Kontchou G, Mahamoudi A, Aout M, et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic in 235 Western patients with cirrhosis. Hepatology. 2009;50:1475–83.
Waki K, Aikata H, Katamura Y, et al. Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: results and prognostic factors on long-term follow up. J Gastroenterol Hepatol. 2010;25:597–604.
Zytoon AA, Ishii H, Murakami K, et al. Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome. Jpn J Clin Oncol. 2007;37:658–72.
Kim YS, Rihm H, Cho OK, Koh BH, Kim Y. Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors. Eur J Radiol. 2006;59:432–41.
Tateishi R, Shiina S, Teratani T, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer. 2005;103:1201–9.
Kei SK, Rhim H, Choi D, Lee WJ, Lim HK, Kim YS. Local tumor progression after radiofrequency ablation of liver tumors: analysis of morphologic pattern and site of recurrence. AJR Am J Roentgenol. 2008;190:1544–51.
Hori T, Nagata K, Hasuike S, et al. Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol. 2003;38:977–81.
Fernandes ML, Lin CC, Lin CJ, Chen WT, Lin SM. Risk of tumor progression in early-stage hepatocellular carcinoma after radiofrequency ablation. Br J Surg. 2009;96:756–62.
Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226:441–51.
Livraghi T, Lazzaroni S, Meloni F, Solbiati L. Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Br J Surg. 2005;92:856–8.
Llovet JM, Vilana R, Brú C, et al. Barcelona Clinic Liver Cancer (BCLC) Group. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology. 2001;33:1124–9.
Lam VW, Ng KK, Chok KS, et al. Risk factors and prognostic factors of local recurrence after radiofrequency ablation of hepatocellular carcinoma. J Am Coll Surg. 2008;207:20–9.
Torzilli G, Del Fabbro D, Palmisano A, Marconi M, Makuuchi M, Montorsi M. Salvage hepatic resection after incomplete interstitial therapy for primary and secondary liver tumors. Br J Surg. 2007;94:208–13.
Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary disease: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240:698–710.
Torzilli G, Makuuchi M, Inoue K, et al. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients. Arch Surg. 1999;134:984–92.
Ikai I, Arii S, Okazaki M, et al. Report of the 17th Nationwide Follow-up Survey of Primary Liver Cancer in Japan. Hepatol Res. 2007;37:676–91.
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Sugo, H., Ishizaki, Y., Yoshimoto, J. et al. Salvage Hepatectomy for Local Recurrent Hepatocellular Carcinoma After Ablation Therapy. Ann Surg Oncol 19, 2238–2245 (2012). https://doi.org/10.1245/s10434-012-2220-y
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DOI: https://doi.org/10.1245/s10434-012-2220-y