Risk factors and prognosis of patients with recurrent hepatocellular carcinoma who undergo liver re-resections

Background: Management of recurrent hepatocellular cancer (HCC) after liver resection is challenging, with unsatisfactory long-term patient outcomes. Liver re-resection, in theory, is a good treatment option. We therefore studied prognosis and risk factors of patients who undergo re-hepatectomy. Methods: We retrospectively analyzed 103 patients who underwent re-hepatectomy. Results: The re-resection postoperative complication rate was 31.1% (32/103). Patients with gross vascular invasion (GVI), cirrhosis, or hepatitis B (HBV) infections not treated with antiviral therapy had higher morbidity than patients without these diseases (per chi-square tests). In bivariate regression analysis, cirrhosis (odds ratio [OR]: 10.308, P= 0.031) and HBV not treated with antiviral therapy (OR: 3.982, P= 0.011) were associated with immediate postoperative morbidity. Median overall survival (OS) after re-resection was 65.0 months (range: 2.1-119.3 months); cumulative OS rates were 1-year: 92.1%, 2-year: 78.2%, and 5-year: 54.4%. Independent risk factors for worse survival were serum AFP level > 20 ng/mL at first resection, portal hypertension (PH) and GVI at recurrence. In the non-PH group, microvascular invasion (micro-VI), GVI and pTNM Ill-IV disease were associated with poor prognosis; patients with pTNM I-II disease had significantly less micro-VI and GVI than did patients with advanced disease. Conclusion: Repeat hepatectomy has favorable long-term outcomes. Cirrhosis and HBV not treated with antiviral therapy were associated with immediate postoperative morbidity. Serum AFP > 20 ng/mL at first resection, PH, and GVI at recurrence are independent prognostic factors. For patients without PH, TNM staging can predict prognosis. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.