Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;407(6):2381-2391.
doi: 10.1007/s00423-022-02545-1. Epub 2022 May 23.

The role of re-resection in recurrent hepatocellular carcinoma

Jan Bednarsch  1 , Zoltan Czigany  1 , Lara R Heij  1   2 , Iakovos Amygdalos  1 , Daniel Heise  1 , Philip Bruners  3 , Tom F Ulmer  1 , Ulf P Neumann  1   4 , Sven A Lang  5
Affiliations

The role of re-resection in recurrent hepatocellular carcinoma

Jan Bednarsch et al. Langenbecks Arch Surg. 2022 Sep.

Abstract

Purpose: While liver resection is a well-established treatment for primary HCC, surgical treatment for recurrent HCC (rHCC) remains the topic of an ongoing debate. Thus, we investigated perioperative and long-term outcome in patients undergoing re-resection for rHCC in comparative analysis to patients with primary HCC treated by resection.

Methods: A monocentric cohort of 212 patients undergoing curative-intent liver resection for HCC between 2010 and 2020 in a large German hepatobiliary center were eligible for analysis. Patients with primary HCC (n = 189) were compared to individuals with rHCC (n = 23) regarding perioperative results by statistical group comparisons and oncological outcome using Kaplan-Meier analysis.

Results: Comparative analysis showed no statistical difference between the resection and re-resection group in terms of age (p = 0.204), gender (p = 0.180), ASA category (p = 0.346) as well as main preoperative tumor characteristics, liver function parameters, operative variables, and postoperative complications (p = 0.851). The perioperative morbidity (Clavien-Dindo ≥ 3a) and mortality were 21.7% (5/23) and 8.7% (2/23) in rHCC, while 25.4% (48/189) and 5.8% (11/189) in primary HCC, respectively (p = 0.851). The median overall survival (OS) and recurrence-free survival (RFS) in the resection group were 40 months and 26 months, while median OS and RFS were 41 months and 29 months in the re-resection group, respectively (p = 0.933; p = 0.607; log rank).

Conclusion: Re-resection is technically feasible and safe in patients with rHCC. Further, comparative analysis displayed similar oncological outcome in patients with primary and rHCC treated by liver resection. Re-resection should therefore be considered in European patients diagnosed with rHCC.

Keywords: HCC; Re-resection; Surgery; Tumor recurrence.

PubMed Disclaimer

Conflict of interest statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was conducted at the UH-RWTH in accordance with the requirements of the Institutional Review Board of the RWTH-Aachen University (EK EK 503/21). All authors declare no conflict of interest.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Oncological survival in hepatocellular carcinoma of the study cohort. A: Overall survival. The median OS of the cohort was 41 months (95%CI: 33–49 months). B: Recurrence-free survival. The median RFS of the cohort was 26 months (95%CI: 17–34 months). OS, overall survival; RFS, recurrence-free survival
Fig. 2
Fig. 2
Oncological survival in hepatocellular carcinoma stratified by resection and re-resection. A: Overall survival. Patients undergoing primary resection showed a median OS of 40 months compared to 41 months in patients undergoing re-resection (p = 0.836 log rank). B: Recurrence-free survival. Patients undergoing primary resection showed a median RFS of 26 months compared to 29 months in patients undergoing re-resection (p = 0.946 log rank). OS, overall survival; RFS, recurrence-free survival
See this image and copyright information in PMC

References

    1. Siegel R, Naishadham D. Jemal A (2012) Cancer statistics for Hispanics/Latinos. CA: Cancer J Clin. 2012;62(5):283–298. doi: 10.3322/caac.21153. - DOI - PubMed
    1. Lurje G, Bednarsch J, Czigany Z, Amygdalos I, Meister F, Schoning W, Ulmer TF, Foerster M, Dejong C, Neumann UP. Prognostic factors of disease-free and overall survival in patients with hepatocellular carcinoma undergoing partial hepatectomy in curative intent. Langenbeck's archives of surgery/Deutsche Gesellschaft fur Chirurgie. 2018;403(7):851–861. doi: 10.1007/s00423-018-1715-9. - DOI - PubMed
    1. Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology. 2016;150(4):835–853. doi: 10.1053/j.gastro.2015.12.041. - DOI - PubMed
    1. Vitale A, Burra P, Frigo AC, Trevisani F, Farinati F, Spolverato G, Volk M, Giannini EG, Ciccarese F, Piscaglia F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Cabibbo G, Felder M, Gasbarrini A, Sacco R, Foschi FG, Missale G, Morisco F, Svegliati Baroni G, Virdone R, Cillo U, Cancer IL, g, Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study. J Hepatol. 2015;62(3):617–624. doi: 10.1016/j.jhep.2014.10.037. - DOI - PubMed
    1. Roayaie S, Jibara G, Tabrizian P, Park JW, Yang J, Yan L, Schwartz M, Han G, Izzo F, Chen M, Blanc JF, Johnson P, Kudo M, Roberts LR, Sherman M. The role of hepatic resection in the treatment of hepatocellular cancer. Hepatology. 2015;62(2):440–451. doi: 10.1002/hep.27745. - DOI - PubMed