Application and Outcomes of Repeat Hepatectomy for Recurrent Hepatocellular Carcinom

PURPOSE: The effective treatment of an intrahepatic recurrent hepatocellular carcinoma (HCC) after a curative resection is very important in improving the prognosis after resection of HCC. The purposes of this study were to evaluate the clinicopathological characteristics and clarify the outcome of the patients after a repeat hepatectomy for a recurrent HCC. METHODS: Between March 1991 and February 2004, 16 patients underwent repeat hepatectomy for a recurrent HCC at the Yeungnam university hospital. The clinicopathological and follow-up data were retrospectively analyzed. RESULTS: There was no significant difference in the average of ICG R15 between the primary (11.2+/-1.8%) and repeat hepatectomy (18.2+/-2.8%). There were a higher proportion of minor (Couinaud's segment < or =2) resection in the repeat (93.8%) than the primary hepatectomy groups (75.0%), but the difference was not statistically significant. A significant difference was seen in the tumor size between the primary (3.6+/-0.5 cm) and repeat hepatectomy groups (2.9+/-1.9 cm). The average number of tumor in both the primary and repeat hepatectomy was equal (1.3+/-0.6). The number of cases of multicentric occurrence of HCC (12 cases) was more than that of intrahepatic metastasis of HCC (4 cases). The mean interval between the primary and repeat hepatectomy was 48.0+/-33.0 months (13~136 months). The average survival time after a primary hepatectomy was 83.6+/-36.3 months. The cumulative 1, 3, 5, and 7 year survival rates were 100, 100, 85.9, and 75.3% after a primary hepatectomy and 90, 56.5, 56.5 and 56.5% after a repeat hepatectomy, respectively. CONCLUSION: A repeat hepatectomy leads to a satisfactory outcomes in selected HCC patients.

Surgical Treatment of Ruptured Hepatocellular Carcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: Spontaneous rupture causing massive hemoperitoneum is a potentially life-threatening complication of hepatocellular carcionma (HCC). Hepatic resection provides the only hope of cure for patients with a ruptured HCC. So we reviewed our clinical experience with surgical treatments for ruptured HCC. METHODS: Between October 1990 and April 2003, twelve cases were treated with liver resection for ruptured HCC at our department. The clinical records were reviewed retrospectively. RESULTS: Twelve patients underwent hepatectomy. Ages ranged from 44 to 69 years with a mean age of 54.4 years, and sex ratio was 5:1 with a male dominence. Liver cirrhosis was presented in 9 cases (75%). 9 cases of them underwent staged hepatectomy; the other 3 underwent emergency hepatectomy. Three patients were treated by transcatheter arterial embolization (TAE) before staged hepatectomy. The median survival time were 40 (4~2) months, and overall 1-year and 3-year cumulative survival rates were 81% and 36%. CONCLUSION: Surgical resection is the only procedure associated with long-term survival for resectable ruptured HCC with good liver function. With or without preoperative TAE, elective hepatectomy is a rational treatment for patients with ruptured HCC.