Surgical Resection versus Re-Ablation for Intrahepatic Recurrent Hepatocellular Carcinoma after Initial Ablation Therapy

Abstract

<b><i>Background and Aims:</i></b> Whether surgical resection or repeated ablation should be recommended for intrahepatic recurrent hepatocellular carcinoma (HCC) conforming to the Milan criteria after initial ablation remains unclear. In this study, we compared the outcomes of patients who underwent surgical resection with those who underwent re-ablation for recurrent HCC after initial curative-intent ablation. <b><i>Methods:</i></b> The data of 28 and 98 patients who underwent surgical resection and re-ablation, respectively, for recurrent HCC after initial ablation between January 2003 and 2017 were analyzed using propensity score matching. <b><i>Results:</i></b> Before matching, the 1-, 3-, and 5-year overall survival (OS) rates were 95.7, 83.0, and 74.4% for the ablation group, compared to 92.9, 89.1, and 70.9% for the resection group (<i>p</i> = 0.490). The corresponding disease-free survival (DFS) rates were 67.5, 40.1, and 25.6% for the ablation group and were 85.4, 59.9, and 53.3% for the resection group (<i>p</i> = 0.018). After matching, the 1-, 3-, and 5-year OS rates for the ablation and resection group were 95.2, 85.5 and 81.8% versus 96.0, 96.0, and 76.4%, respectively (<i>p</i> = 0.550). The 1-, 3-, and 5-year DFS rates were 58.0, 39.5, and 29.9% for the ablation group and were 95.8, 67.2, and 59.8% for the resection group (<i>p</i> = 0.004). Cox proportional hazards model identified surgical resection as the only significant prognostic factor for DFS but not for OS. <b><i>Conclusion:</i></b> For intrahepatic recurrent HCC patients after initial ablation, surgical resection could provide better DFS than re-ablation, while no difference in OS was observed between the 2 treatment groups.

Repeat hepatectomy versus thermal ablation therapy for recurrent hepatocellular carcinoma: a systematic review and meta-analysis

“…The HR data from 14 studies ( 10 – 12 , 16 – 18 , 27 , 28 , 31 – 33 , 35 , 37 , 38 ) on RFS were included for meta-analysis. Given the low heterogeneity among the study groups (I 2 = 0%), a fixed effect model was employed for data integration.…”

“…Ten studies (12,16,18,25,31,32,(35)(36)(37)(38) provided data on severe postoperative complications (Clavien-Dindo grade III or higher).The incidence of severe postoperative complications was 11.4% (88/769) in the RH group and 3.6% (31/860) in the TAT group. The heterogeneity of these trials was moderate (I 2 = 53%); therefore, a random effects model was employed to pool data.…”

“…Eleven studies (12,16,18,28,(31)(32)(33)(35)(36)(37)(38) provided perioperative mortality. The perioperative mortality of the RH group was 0.5% (4/805), while that of the TAT group was 0.2% (2/ 890).…”

Outcomes after primary and repeat thermal ablation of hepatocellular carcinoma with or without liver transplantation

“…Manual screening revealed two studies which reported on survival after repeat TA following primary TA [13,14]. Both were performed in Asian populations, with comparatively young patients (median age 50 [13], and 60 [14]), with almost exclusively viral hepatitis-induced HCC. One study reported a number of non-cirrhotic patients above 30% [13].…”