Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy

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Abstract
BACKGROUND: Resection of hepatocellular carcinoma (HCC) is associated with a high incidence of recurrence. Aggressive management of recurrence is an important strategy in prolonging survival. This study evaluated the role of combined resection and locoregional therapy in the management of selected patients with extrahepatic and intrahepatic recurrences. STUDY DESIGN: From a prospective database of 399 patients with hepatectomy for HCC from 1989 to 1998, 63 patients were identified with extrahepatic and intrahepatic recurrences either concurrently or sequentially. Survival outcomes of patients who underwent resection of extrahepatic recurrence and re-resection or locoregional therapy for intrahepatic recurrence were evaluated. RESULTS: Ten patients underwent resection of solitary extrahepatic recurrence and locoregional therapy for intrahepatic recurrence. Transarterial chemoembolization was the main treatment modality for intrahepatic recurrence. Two of these patients also underwent re-resection of intrahepatic recurrence at the time of resection of extrahepatic metastasis. Median survival after recurrence of these 10 patients was 44.0 months (range 18.6 to 132.9 months), and the median overall survival from initial hepatectomy was 49.0 months (range 21.6 to 134.6 months). In contrast, median survival after recurrence of the remaining 53 patients with extrahepatic and intrahepatic recurrences treated by nonsurgical means (locoregional therapy, systemic chemotherapy, or hormonal therapy) was only 10.6 months (p = 0.002). CONCLUSIONS: Aggressive management with combined resection of isolated extrahepatic recurrence and re-resection or locoregional therapy for intrahepatic recurrence may offer longterm survival in selected patients who develop both intrahepatic and extrahepatic recurrences after hepatectomy for HCC.