TREATMENT OF INTRAHEPATIC RECURRENCE AFTE R RESECTION OF HEPATOCELLULAR-CARCINOMA

Between October 1990 and December 1995, 86 patients underwent hepatic resection for hepatocellular carcinoma (HCC). All resections were carr ied out with the aim of achieving complete cure. Fifty one (60 %) of t hese patients subsequently developed recurrent HCC. Only twenty patien ts could be treated in our hospital. There were 18 men and 2 women, wi th a mean age of 61 years at the time of recurrence. Six patients had a normal liver. Fourteen patients had associated liver cirrhosis. Usin g Pugh's classification, 7 patients were Pugh A, 6 Pugh B and 1 Pugh C . The initial hepatic resection had consisted of major hepatectomy in 9 cases and segmentectomy in the remaining 11 patients. The mean time to recurrence was 17 months. There were 3 recurrences on the resection margin and 17 recurrences away from the hepatic stump. The therapeuti c choice after hepatic recurrence was based on the number of tumors, h epatic function and the size of the liver remnant. Six patients were t reated by tamoxifen due to poor hepatic function; median survival afte r recurrence was 6 months. Four patients with a single recurrent tumor on an atrophied liver remnant were treated by percutaneous ethanol in jection with a median survival after recurrence of 15 months. Five pat ients with multiple diffuse lesions and good hepatic function were tre ated by transarterial chemoembolisation with a median survival after r ecurrence of 30 months. Five patients with a solitary tumor and good h epatic function underwent a second hepatic resection with a median sur vival after recurrence of 35 months. The overall median survival after diagnosis of recurrence was 20 months. These results suggest that an active treatment should be carried our in cases of recurrence of HCC. A second resection, if technically possible, offers the best chance of survival.