Salvage hepatectomy for local recurrent hepatocellular carcinoma after ablation therapy.
BACKGROUND
The results of salvage hepatectomy for local recurrent hepatocellular carcinoma after incomplete percutaneous ablation therapy are still unclear.


METHODS
We conducted a retrospective analysis of 197 consecutive patients with hepatocellular carcinoma who underwent either salvage hepatectomy after prior incomplete percutaneous ablation therapy (salvage group; n=23) or primary hepatectomy as the initial treatment (primary group; n=174). The two groups were compared with respect to intraoperative data, operative mortality and morbidity, and long-term survival.


RESULTS
The salvage group showed a significantly longer operation time (385 vs. 300 min; P=0.006) and a significantly greater intraoperative blood loss volume (402 vs. 265 ml; P=0.024). The postoperative mortality rate was zero in both groups, and the morbidity rates were similar. Although the 1-, 3-, and 5-year disease-free survival rates after hepatectomy were significantly worse in the salvage group than in the primary group (65%, 41%, and 33% vs. 81%, 51%, and 45%, respectively; P=0.031), the overall survival rates after hepatectomy did not differ significantly (91%, 91%, and 67% vs. 96%, 79%, and 65%, respectively; P=0.790). The 1-, 3-, and 5-year overall survival and disease-free survival rates after percutaneous ablation therapy were also not different from those in the primary group (100, 96, and 83%, P=0.115; and 96, 60, and 45%, P=0.524, respectively).


CONCLUSIONS
The short-term and long-term results of salvage hepatectomy after incomplete percutaneous ablation therapy are equivalent to those of primary hepatectomy. Salvage hepatectomy is an acceptable treatment for patients with local recurrence of hepatocellular carcinoma after ablation therapy.
Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Hiroyuki
H
Sugo
Yoichi
Y
Ishizaki
Jiro
J
Yoshimoto
Hiroshi
H
Imamura
Seiji
S
Kawasaki
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D015996:Survival Rate; D013997:Time Factors