Long-term outcomes after hepatectomy for recurrences after prior local ablation for hepatocellular carcinoma.

摘要

AIMS: Intrahepatic recurrence is the most common manifestation of failure after local ablation therapy for hepatocellular carcinoma. The present study evaluates the safety and efficacy of partial hepatectomy for intrahepatic recurrence after prior local ablation. METHODS: A retrospective analysis was conducted of 188 consecutive patients with hepatocellular carcinoma who underwent either partial hepatectomy for recurrence after prior local ablation (n=13) or partial hepatectomy as initial local treatment (n=175). The 13 patients with recurrence after prior local ablation were referred to our division after the resectable recurrences were considered to be resistant to non-surgical treatment modalities. RESULTS: The incidences of postoperative morbidity and mortality were similar for patients with prior local ablation and patients without prior local ablation (p=0.75 and p=0.52, respectively). The overall survival rates after hepatectomy were comparable between patients with prior local ablation (median survival time of 86months; cumulative 5-year survival rate of 63%) and patients without prior local ablation (median survival time of 76months; cumulative 5-year survival rate of 54%; p=0.60). The disease-free survival rates after hepatectomy were significantly worse for patients with prior local ablation based on both univariate (p=0.01) and multivariate (relative risk, 2.73; p<0.01) analyses. CONCLUSIONS: Hepatectomy can be performed safely and may be efficacious, in terms of overall survival, for selected patients with intrahepatic recurrence after prior local ablation for hepatocellular carcinoma. On the other hand, prior local ablation appears to increase the probability of failure after hepatectomy.