A clinical study on salvage hepatectomy for treating recurrent liver cancer after radiofrequency ablation

摘要

Objective We studied the efficacy of salvage hepatectomy for treating recurrent hepatic cancer after radiofrequency ablation(RFA). Methods A retrospective analysis of 67 patients who had recurrent liver cancer after RFA treatment and received salvage hepatectomy in the Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University(China), from January 2006 to January 2014, was performed. The analysis included patient gender, age, hepatitis type, alpha-fetoprotein(AFP), and TNM stage prior to RFA and salvage hepatectomy, overall survival rates, and tumor-free survival rates after salvage hepatectomy. Results Among the 67 patients, there were 57 cases of hepatitis B, two cases of hepatitis C, and eight cases did not have hepatitis. AFP levels in patients ranged from 3 to 4521 ng/m L(median 33 ng/m L). Before RFA, 54 cases were stage I tumors, and 13 were stage II tumors. Tumor sizes varied from 0.82 to 4.83 cm(median 3.0 cm). In 20 cases, one RFA was performed, and for 47 cases, RFA was repeated. RFAablated region diameters ranged from 3.8 to 5.2 cm(median 4.5 cm). The interval between the salvage surgical resection and RFA was 3–37 months. Before salvage hepatectomy, 23 stage I tumors, 12 stage II tumors, and 32 stage III tumors were present(size ranged 4.83–11.84 cm; median 6.3 cm). For salvage hepatectomy, laparotomy was performed for 56 cases, and laparoscopy was performed for 28 cases. Inflow clamping was performed for 39 cases(15–45 min). Surgery was 219–370 min and intraoperative blood loss was 100–2100 m L. For 13 cases, intraoperative blood transfusion was required. Tumor pathological data revealed 31, 35, and 1 poorly, moderately, and well differentiated tumors, respectively. No patients died due to operative complications, and hospital stays were 8–10 days. Overall and tumor-free survival rates were 85% and 79% for 1 year, 50% and 20% for 3 years, and 39% and 19% for 5 years, respectively. KaplanMeier analysis and Cox regression confirmed that tumor number and size prior to salvage liver cancer were risk factors affecting survival. Conclusion Patients who received RFA to treat early-stage liver cancer with postoperative recurrent stage I tumors have satisfactory outcomes with salvage hepatectomy.