Abstract
From 1978 to 1989, 164 patients underwent hepatic resection for hepatocellular carcinoma at our institution. The carcinoma was resected completely in 149 patients. Sixteen patients were excluded from this study because it was not known whether they were recurrent or disease free, or because death occurred as a result of surgical complications. Recurrent disease occurred in 48.1% of the remaining 133 patients. Fifty-seven patients had recurrent tumor only in the residual liver. A second hepatic resection was performed in 14 cases, 22 received intraarterial chemotherapy and/or arterial embolization without resection, and the remaining 21 received no anticancer therapy. The 5-year survival rate of patients who had a second resection was 92.0%. Recurrences in distant organs occurred in 14 patients, and the recurrent carcinoma was resected in five cases. Four of these 5 patients survived more than 3 years after the second surgery. Aggressive surgical resection of recurrent HCC, even for distant metastasis, is a viable approach, and may produce long-term survivors.
Résumé
Entre 1978 et 1989, 164 patients ont eu une résection hépatique pour carcinome hépatocellulaire. La résection a été considérée comme totale chez 149 patients. Après exclusion de 16 patients soit parce que leur état (récidive ou sans maladie) n'était pas connu soit parce qu'ils étaient décédés pendant leur hospitalisation en raison de complications postopératoires, une récidive a été constatée chez 48.1% des 133 patients restants. Parmi ceux-ci, 57 ont eu une récidive du parenchyme seul. Une deuxième résection a été pratiquée chez 14, une chimiothérapie intra-artérielle et/ou embolisation artérielle sans résection chez 22 alors que les 21 autres patients n'ont pas eu de traitement anticancéreux. La survie à 5 ans des patients qui ont eu une deuxième résection a été de 92.0%. La récidive a touché un autre organe chez 14 patients et s'est prêtée à une deuxième résection dans cinq cas. Quatre de ces cinq patients ont survécu plus de trois ans après cette chirurgie secondaire. Une attitude chirurgicale aggressive de la récidive de carcinome hépatocellulaire, même en cas de métastases à distance, est valable et dans quelques cas, une survie prolongée peut se voir.
Resumen
Ciento sesenta y cuatro pacientes fueron sometidos a resecciôn hepática por carcinoma hepatocelular en el período entre 1978 y 1989 en nuestra instituciôn. La resección del tumor fue completa en 149 pacientes. Dieciseis fueron excluídos del estudio porque en el seguimiento no se pudo establecer si se encontraban con tumor recurrente o libres de enfermedad, o porque los pacientes murieron en el hospital como consecuencia de complicaciones operatorias en el primer mes después de la cirugía.
Se présentó enfermedad recurrente en 48.1% de los 133 pacientes restantes; 57 pacientes presentaron el tumor recurrente en el parenquima hepático residual sólamente, y se practicó una segunda resección hepática en 14; 22 recibieron quimioterapia intra-arterial y/o embolización arterial sin resección y los 21 restantes no recibieron quimioterapia antitumoral. La tasa de sobrevida a 5 años de los pacientes sometidos a una segunda resección fué 92%.
Se presentó recurrencia en órganos distantes en 14 pacientes, y el tumor recurrente fue resecado en cinco. Cuatro de los cinco sobreviven más de 3 anos después de la segunda resección. La resección agresiva del carcinoma hepatocelular recurrente es un aproche viable, aún en el caso de metástasis distantes, y puede dar lugar a prolongadas superviviencias.
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Nakajima, Y., Ohmura, T., Kimura, J. et al. Role of surgical treatment for recurrent hepatocellular carcinoma after hepatic resection. World J. Surg. 17, 792–795 (1993). https://doi.org/10.1007/BF01659099
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DOI: https://doi.org/10.1007/BF01659099