Surgical Strategies for Recurrent Hepatocellular Carcinoma after Resection: A Review of Current Evidence

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, and both liver resection and liver transplantation are considered potentially curative options. However, high recurrence rates affect the prognosis depending both on the primary HCC pathology characteristics or on the type and time of the relapse. While great attention has been usually posted on treatment algorithms for the first HCC, treatment algorithms for recurrent HCC (rHCC) are lacking. In these cases, surgery still represents a curative option with both redo hepatectomy and/or salvage liver transplantation, which are considered valid treatments in selected patients. In the current era of personalised medicine with promises of new systemic-targeted immuno-chemotherapies, we wished to perform a narrative review of the literature on the role of surgical strategies for rHCC.

Keywords: hepatocellular carcinoma; liver resection; liver transplant; recurrent hepatocellular carcinoma; salvage liver transplant; surgical management.

Figure 1

Intrahepatic metastasis (IM). (A) Local recurrence: the rHCC develops along the tumour blood flow (TBF) (B) Systemic recurrence: caused by circulating tumour cells (CTCs) in the rehoming of the remnant liver.

Figure 2

Multicentric occurrence (MO). Multiple nodular disease with well-differentiated carcinoma surrounding a less-differentiated mass (known as “nodule in nodule” form).