Surgical Strategies for Recurrent Hepatocellular Carcinoma after Resection: A Review of Current Evidence

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, and both liver resection and liver transplantation are considered potentially curative options. However, high recurrence rates affect the prognosis depending both on the primary HCC pathology characteristics or on the type and time of the relapse. While great attention has been usually posted on treatment algorithms for the first HCC, treatment algorithms for recurrent HCC (rHCC) are lacking. In these cases, surgery still represents a curative option with both redo hepatectomy and/or salvage liver transplantation, which are considered valid treatments in selected patients. In the current era of personalised medicine with promises of new systemic-targeted immuno-chemotherapies, we wished to perform a narrative review of the literature on the role of surgical strategies for rHCC.

Recurrence Pattern Is an Independent Surgical Prognostic Factor for Long-Term Oncological Outcomes in Patients with Hepatocellular Carcinoma

“…Recurrence is consistently a crucial concern in curative treatment for HCC, prompting studies aimed at predicting the likelihood of recurrence. The ERASL model that included over 3000 cases showed that the male sex, ALBI grade, microscopic invasion, AFP, tumor size, and number of lesions could be incorporated to predict the possibility at a cut-off value; furthermore, the model indicated that risk factors could be stratified from low- to high-risk groups [ 19 , 20 , 21 ]. Higher serologic factors, such as AFP and des-γ-carboxyprothrombin (DCP), tumor volume, multiple nodules, microvascular invasion, and poorly differentiated types have been assumed to be aggressive tumor factors.…”

“One-stop” synergistic strategy for hepatocellular carcinoma postoperative recurrence

“…Residual tumor recurrence after HCC surgical resection, strongly associated with poorer clinical outcomes and overall survival, remains a considerable challenge in clinical practice [ 54 ]. Recently, various nanomaterials with photothermal conversion [ 55 ], photodynamic properties [ 56 , 57 ], enzyme catalysis [ 58 ], and immunomodulation [ 59 ] have attracted widespread attention and have been applied to antitumor therapy.…”

Threatment Strategies for Recurrent Hepatocellular Carcinoma Patients: Ablation and its Combination Patterns

“…At the time of recurrence, the prognosis of rHCC patients depend on age, platelet count, the AFP value, the number of visually visible recurrent tumors, tumors size, gross vascular invasion, Child‒Pugh classification, coexisting liver disease and severity 6 , 7 . Thus, it is important to thoroughly and carefully assess liver function and portal hypertension status before administering anti-tumor therapy.…”