Postoperative Recurrence of Hepatocellular Carcinoma

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Abstract
Objectives: To report the results of our investigation of the postoperative intrahepatic recurrent rates and the patterns of recurrence and to determine the factors that influenced these patterns of recurrence. Design: Case series. Setting: Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. Patients: Between 1977 and 1991, 162 men and 43 women with hepatocellular carcinoma underwent hepatic resection. Results: The surgical mortality rate was 4.4%. Of the 196 patients who were discharged from the hospital, 114 have since died and 20 were not available for follow-up. The overall cumulative recurrent rates for the last 5 years (1987 through 1991) were 59.7%, 65.0%, 76.5%, 77.0%, and 79.7%, respectively. Eighty patients experienced intrahepatic recurrence. Of these, 21 (26.2%) had recurrence near the resected stump, 43 (53.8%) had a single nodular recurrence in the remnant liver, and 16 (20%) had widespread multinodular recurrence. The patients with resected margins of less than 1 cm in diameter had relatively higher recurrence rates than those with resected margins of greater than 1 cm in diameter. All recurrences were noted within 3 years of the resection. The preoperative serum α-fetoprotein levels were directly related to the length of time to recurrence (ie, the higher the serum α-fetoprotein level, the sooner the recurrence). Conclusions: The postoperative intrahepatic remnant rate is very high; 80% by 5 years after resection. The preoperative serum α-fetoprotein level and adequacy of the cut margin significantly influenced the recurrence rate. (Arch Surg. 1994;129:738-742)