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Liver Resection Versus Embolization for Recurrent Hepatocellular Carcinoma

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Abstract

Background

Despite curative resection, hepatocellular carcinoma (HCC) has a high probability of recurrence. We validated the potential role of liver resection (LR) for recurrent HCC.

Methods

Patients with intrahepatic recurrence with up to three lesions were included. We compared survival times of patients undergoing their first LR to those of patients undergoing repeated LR. Then, survival times of the patients who had undergone LR and transcatheter chemoembolization (TACE) for recurrent HCC after propensity score matching were compared.

Results

After a median follow-up period of 3.1 years (range, 0.2–16.3), median overall survival times were 6.5 years (95% CI 6.0–7.0), 5.7 years (5.2–6.2), and 5.1 years (4.9–7.3) for the first LR (n = 1234), second LR (n = 273), and third LR (n = 90) groups, respectively. Severe complications frequently occurred in the first LR group (p = 0.059). Operative times were significantly longer for the third LR group (p = 0.012). After the first recurrence, median survival times after one-to-one pair matching were 5.7 years (95% CI 4.5–6.5) and 3.1 years (2.1–3.8) for the second LR group (n = 146) and TACE group (n = 146), respectively (p < 0.001). The median survival time of the third LR group (n = 41) (6.2 years; 95% CI 3.7–NA) was also longer than that of TACE group (n = 41) (3.4 years; 1.8–4.5; p = 0.010) after the second recurrence.

Conclusions

Repeated LR for recurrent HCC is the procedure of choice if there are three or fewer tumors.

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Funding

This research was supported by AMED under Grant Number JP18hk0102049 and a Grants-in-aid of the 106th Annual Congress of JSS Memorial Surgical Research Fund, Tokyo, Japan.

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Authors and Affiliations

  1. Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan

    Yutaka Midorikawa, Tadatoshi Takayama, Masamichi Moriguchi, Rempei Yagi, Shunsuke Yamagishi, Hisashi Nakayama, Osamu Aramaki, Shintaro Yamazaki & Tokio Higaki

  2. Genome Science Division, Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan

    Shingo Tsuji

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  1. Yutaka Midorikawa
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  2. Tadatoshi Takayama
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  3. Masamichi Moriguchi
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  5. Shunsuke Yamagishi
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  10. Tokio Higaki
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Correspondence to Yutaka Midorikawa.

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Midorikawa, Y., Takayama, T., Moriguchi, M. et al. Liver Resection Versus Embolization for Recurrent Hepatocellular Carcinoma. World J Surg 44, 232–240 (2020). https://doi.org/10.1007/s00268-019-05225-2

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