Management of hepatocellular carcinoma recurrence after liver surgery and thermal ablations: state of the art and future perspectives

Abstract

Despite the improvements in surgical and medical therapy for hepatocellular carcinoma (HCC), recurrence still represents a major issue. Up to 70% of patients can experience HCC recurrence after liver resection (LR), as well as 20% of them even after liver transplantation (LT). The patterns of recurrence are different according to both the time and the location. Similarly, the risk factors and the management can change not only according to these patterns, but also according to the underlying liver condition and to the first treatment performed. Deep knowledge of such correlation is fundamental, since prevention and effective management of recurrence are undoubtedly the most important strategies to improve the outcomes of HCC treatment. Without adjuvant therapy, maintaining very close monitoring during the first 2 years in order to diagnose curable recurrence and continue this monitoring beyond 5 years because late recurrences exist, remains our only possibility today. Surgery represents the cornerstone treatment for HCC, including both LT and LR. However, new interesting therapeutic opportunities are coming from immunotherapy that has shown encouraging results also in the adjuvant setting. In such a complex and evolutionary scenario, the aim of this review is to summarize current strategies for the management of HCC recurrence, focusing on the different possible scenarios, as well as on future perspectives

Lower Geriatric Nutritional Risk Index and Prognostic Nutritional Index Predict Postoperative Prognosis in Patients with Hepatocellular Carcinoma

“…Recurrence is a major complication in the surgical treatment of patients with HCC. The risk factors for recurrence, the usefulness of adjuvant therapy to prevent recurrence, and the management of recurrence after resection have been investigated previously [17]. However, the prevention and management of recurrence are controversial.…”

“…The timing and location of recurrence are particularly related to prognosis. Herrero et al [17] reported that 12 months was the most useful cutoff time period to define early recurrence after surgery from recent larger multicenter studies [23,24]. Early recurrence commonly interacts with tumor-related factors such as AFP, tumor number, tumor size, poor differentiation, and vascular invasion [25,26].…”