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Repeat operation for nodular recurrent hepatocellular carcinoma within the cirrhotic liver remnant: A comparison with transcatheter arterial chemoembolization

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Abstract

Management of recurrent hepatocellular carcinoma in a cirrhotic liver remnant is a difficult but challenging problem. To investigate the difference in survival between treatment by repeat resection and treatment by transcatheter arterial chemoembolization (TAE), a retrospective controlled study was conducted. Four patients with nodular recurrence received limited second operations which included right hepatic segmentectomy (2 patients), left lateral segmentectomy (1 patient), and subsegmental wedge resection (1 patient). Eight matched patients received a total of 16 repeated sessions of chemoembolizations. Complications of the TAE group consisted of gastrointestinal bleeding (2 patients), acute pancreatitis (1 patient), and acute cholecystitis (1 patient). No complication developed in the resection group. The 4 patients undergoing a second operation have survived 21, 26, 34, and 54 months after repeat surgery. Seven (87.5%) of the 8 patients receiving TAE died 4 to 11 months after TAE. The resection group survived significantly longer than the TAE group (p<0.01). Our results suggest that it is more advisable to perform a second operation than to undertake chemoembolizations for patients with cirrhosis and nodular recurrent hepatocellular carcinoma with acceptable functional liver reserve.

Résumé

La récidive d'un carcinome hépatocellulaire sur foie cirrhotique, facteur le plus important dans la détermination de survie à long terme, est un problème difficile mais intéressant. Pour comparer la différence de survie après soit une seconde résection soit une chimioembolization par cathéter transartériel, une étude rétrospective contrôllée a été menée. Quatre patients ayant une récidive de type nodulaire ont été réopérés et ont eu une segmentectomie hépatique droite (2 cas), une segmentectomie latèrale gauche (1 cas), et une sous-segmentectomie (1 cas). Huit autres patients, bien comparables, ont eu un total de 16 chimioembolisations. Des complications enrégistrées dans le groupe de chimioembolisations étaient une hémorragie intestinale (2 cas), une pancréatite aiguë (1 cas), et une cholécystite aiguë (1 cas). Aucune complication n'est survenue dans le groupe chirurgical. Les patients ayant été réopérés sont en vie 21, 26, 34 et 54 mois après leur résection alors que sept des huit patients ayant en une chimioembolisation (87.5%) sont morts entre quatre et onze mois après leur traitement. Cette différence de survie est significativement différente (p<0.01). Nos résultats suggèrent qu'en cas de récidive tumorale chez le cirrhotique, à condition que la réserve fonctionnelle soit suffisante, il vaut mieux réaliser une séconde résection que de pratiquer une chimioembolisation.

Resumen

El carcinoma hepatocelular recurrente, que representa el factor de influencia más importante en cuanto a sobrevida a largo plazo, es un problema difícil y que plantea un desafío relativo a su manejo. Se realizó un estudio retrospectivo con el propósito de investigar la diferencia en la eficacia de la prolongación de la sobrevida mediante las re-resecciones y quimioembolización transarterial (ETA). Cuatro pacientes con recurrencia de tipo nodular fueron sometidos a operaciones secundarias limitadas que incluyeron segmentectomía hepática derecha (2 casos), segmentectomía lateral izquierda (1 caso) y resección subsegmentaria (1 caso). Ocho pacientes semejantes fueron sometidos a 16 sesiones repetidas de quimioembolización. Las complicaciones del grupo de ETA consistieron en sangrado gastrointestinal (2 casos), pancreatitis aguda (1 caso) y colecistitis aguda (1 caso). No se presentaron complicaciones en el grupo de resección. Los cuatro pacientes sometidos a segunda operación han sobrevivido hasta la fecha (21, 26, 34 y 54) meses, respectivamente, después de la re-resección). En tanto que siete de los 8 pacientes (87.5%) sometidos a ETA murieron en el curso de cuatro a once meses después de la ETA, el grupo de reresección tuvo una sobrevida significativamente más prolongada (p<0.01). Nuestros resultados sugieren que es más aconsejable realizar una segunda operación que emprender la quimioembolización en pacientes cirróticos con carcinoma hepatocelular recurrente que posean una reserva funcional hepática aceptable.

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References

  1. Lin, T.Y., Lee, C.S., Chen, K.M., Chen, C.C.: Role of surgery in the treatment of primary carcinoma of the liver: A 31-year experience. Br. J. Surg.74:839, 1987

    PubMed  Google Scholar 

  2. Nagao, T., Goto, S., Kawano N., Inoue, S., Mizuta, T., Morioka, Y., Omori, Y.: Hepatic resection for hepatocellular carcinoma, clinical features and long-term prognosis. Ann. Surg.205:33, 1987

    PubMed  Google Scholar 

  3. Nagasue, N., Yukaya, H., Ogawa, Y., Sasayi, Y., Chabg, Y.C., Niimi, K.: Clinical experience with 118 hepatic resections for hepatocellular carcinoma. Surgery99:694, 1984

    Google Scholar 

  4. Nagasue, N., Yukaya, H.: Liver resection for hepatocellular carcinoma: Results from 150 consecutive patients. Cancer Chemother. Pharmacol.23:S78, 1989

  5. Nagorney, D.M., VanHeerden, J., Ilstrup, M., Adson, M.A.: Primary hepatic malignancy: Surgical management and determinants of survival. Surgery106:740, 1989

    PubMed  Google Scholar 

  6. Yamanaka, N., Okamoto, E.: Conditions favoring long-term survival after hepatectomy for hepatocellular carcinoma. Cancer Chemother. Pharmacol.23:S83, 1989

  7. Ezaki, T., Yukaya, H., Ogawa, Y., Chang, Y.C., Nagasue, N.: Recurrence form of hepatocellular carcinoma after partial hepatic resection. Hepatogastroenterology36:164, 1989

    PubMed  Google Scholar 

  8. Nagasue, N., Yukaya, H., Chang, Y.C., Yamanoi, A., Kohno, H., Hayashi, T., Nakamura, T.: Assessment of pattern and treatment of intrahepatic recurrence after resection of hepatocellular carcinoma. Surg. Gynecol. Obstet.171:217, 1990

    PubMed  Google Scholar 

  9. Matsumata, T., Kanematsu, T., Takenaka, K., Yoshida, Y., Nishizaki, T., Sugimachi, K.: Patterns of intrahepatic recurrence after curative resection of hepatocellular carcinoma. Hepatology9:457, 1989

    PubMed  Google Scholar 

  10. Wheeler, P.G., Melia, W., Dubbins, P., Jones, B., Nunnerley, H., Johnson, P., Williams, R.: Non-operative arterial embolization in primary liver tumors. Br. Med. J.2:242, 1979

    PubMed  Google Scholar 

  11. Yamada, R., Sato, M., Kawabata, M., Nakatsuka, H., Nakamura, K., Takashima, S.: Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology148:397, 1983

    PubMed  Google Scholar 

  12. Sukurai, M., Okamura, J., Kurada, C.: Transcatheter chemoembolization effective for treating hepatocellular carcinoma: A histopathologic study. Cancer54:387, 1984

    PubMed  Google Scholar 

  13. Sasaki, Y., Imaoka, S., Fujjta, M., Miyoshi, Y., Ohigashi, H., Ishikawa, O., Furukawa, H., Koyama, H., Iwanaga, T., Kasugai, H., Kojima, J.: Regional therapy in the management of intrahepatic recurrence after surgery for hepatoma. Ann. Surg.206:20, 1987

    Google Scholar 

  14. Kanematsu, T., Matsumata, T., Takenaka, K., Yoshida, Y., Higashi, H., Sugimachi, K.: Clinical management of recurrent hepatocellular carcinoma after primary resection. Br. J. Surg.75:203, 1988

    PubMed  Google Scholar 

  15. Takayasu, K., Muramatsu, Y., Moriyama, N., Hasegawa, H., Makuuchi, M., Okazaki, N., Hirohashi, S., Tsugane, S.: Clinical and radiologic assessment of the results of hepatectomy for small hepatocellular carcinoma and therapeutic arterial embolization for postoperative recurrence. Cancer64:1848, 1989

    PubMed  Google Scholar 

  16. Nagasue, N., Yukaya, H., Ogawa, Y., Sasaki, Y., Chang, Y.C., Niimi, K.: Second hepatic resection for recurrent hepatocellular carcinoma. Br. J. Surg.73:434, 1986

    PubMed  Google Scholar 

  17. Lange, J.F., Leese, T., Castaing, D., Bismuth, H.: Repeat hepatectomy for recurrent malignant tumors of the liver. Surg. Gynecol. Obstet.169:119, 1989

    PubMed  Google Scholar 

  18. Huguet, C., Bona, S., Nordlinger, B., Lagrange, L., Parc, R., Harb, J., Benard, F.: Repeat hepatic resection for primary and metastatic carcinoma of the liver. Surg. Gynecol. Obstet.171:398, 1990

    PubMed  Google Scholar 

  19. Nagao, T., Inoue, S., Yoshimi, F., Sodeyama, M., Omori, Y., Mizuta, T., Kawano, N., Morioka, Y.: Postoperative recurrence of hepatocellular carcinoma. Ann. Surg.211:28, 1990

    PubMed  Google Scholar 

  20. Soo, C.S., Chuang, V.P., Wallace, S., Charnsangavej, C., Carrasco, H.: Treatment of hepatic neoplasm through extrahepatic collaterals. Radiology147:45, 1983

    PubMed  Google Scholar 

  21. Clouse, M.E., Lee, G.L., Duszlak, E.J., Lokich, J.J., Trey, C., Alday, M.R., Yoburn, D.C., Diamond, J., Crosson, A.W., Ostello, P.: Peripheral hepatic artery embolization for primary and secondary hepatic neoplasms. Radiology147:407, 1983

    PubMed  Google Scholar 

  22. Chuang, V.P., Wallance, S.: Hepatic arterial redistribution for intraarterial infusion of hepatic neoplasm. Radiology135:295, 1980

    PubMed  Google Scholar 

  23. Charnsangavei, C., Chuang, V.P., Wallance, S., Soo, C.S., Bowers, T.: Angiographic classification of hepatic collaterals. Radiology144:485, 1982

    PubMed  Google Scholar 

  24. Jeng, K.S., Chiang, H.J.: Delayed formation of gallstones after transcatheter arterial embolization for hepatocellular carcinoma: Is elective cholecystectomy advisable during hepatectomy? Arch. Surg.124:1319, 1989

    PubMed  Google Scholar 

  25. Jeng, K.S., Ching, H.J.: The role of surgery in the management of unusual complications of transcatheter arterial embolization for hepatocellular carcinoma. World J. Surg.12:362, 1988

    PubMed  Google Scholar 

  26. Hsu, H.C., Wu, T.T., Wu, M.Z., Sheu, J.C., Lee, C.S., Chen, D.S.: Tumor invasiveness and prognosis in resected hepatocellular carcinoma. Clinical and pathological implications. Cancer61:2095, 1988

    PubMed  Google Scholar 

  27. Kanematsu, T., Takenaka, K., Matsumata, T., Furata, T., Sugimachi, K., Inokachi, K.: Limited hepatic resection effective for selected cirrhotic patients with primary liver cancer. Ann. Surg.199:51, 1984

    PubMed  Google Scholar 

  28. Lin, T.Y., Lee, C.S., Chen, C.C., Liau, K.Y., Lin, W.S.J.: Regeneration of human liver after hepatic lobectomy studied by repeated liver scanning and repeated needle biopsy. Ann. Surg.190:48, 1979

    PubMed  Google Scholar 

  29. Gozzetti, G., Mazziotti, A., Cavallari, A., Bellusci, R., Bolondi, L., Grigioni, W., Bragalia, R., Grazi, G.L., DeRaffele, E.: Clinical experience with hepatic resections for hepatocellular carcinoma in patients with cirrhosis. Surg. Gynecol. Obstet.166:503, 1988

    PubMed  Google Scholar 

  30. Makuuchi, M., Hasegawa, H., Yamazaki, S., Takayasu, K., Moriyama, N.: The use of operative ultrasound as an aid to liver resection in patients with hepatocellular carcinoma. World J. Surg.11:615, 1987

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery and Radiology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China

    Kuo-Shyang Jeng M.D. (F.A.C.S.), Fi-Sh Yang M.D., Hsein-Jar Chiang M.D. & Ikuho Ohta M.D.

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  1. Kuo-Shyang Jeng M.D.
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Jeng, KS., Yang, FS., Chiang, HJ. et al. Repeat operation for nodular recurrent hepatocellular carcinoma within the cirrhotic liver remnant: A comparison with transcatheter arterial chemoembolization. World J. Surg. 16, 1188–1191 (1992). https://doi.org/10.1007/BF02067099

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