Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review
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WORLD JOURNAL OF SURGICAL ONCOLOGY Open Access
RESEARCH
Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review Research
Yanming Zhou†1,2, Chengjun Sui†2, Bin Li1, Zhengfeng Yin*3, Yunchang Tan2, Jiamei Yang*2 and Zhenyu Liu3
Abstract Background: This study aimed to assess the efficacy and safety of repeat hepatectomy for recurrent hepatocellular carcinoma (HCC). Methods: Thirty-seven patients who underwent a curative repeat hepatectomy in our hospital were retrospectively studied. An extensive database literature search was performed to obtain for all relevant studies. Results: In our series, there were no perioperative deaths during repeat hepatectomy for recurrent HCC. Patients survival after repeat hepatectomy were similar to 429 patients undergoing initial hepatectomy. A computerized search of the Medline and PubMed databases found 29 retrospective studies providing relevant data in 1149 patients were included for appraisal and data extraction. After the repeat hepatectomy, postoperative morbidity ranged from 6.2% to 68.2% with a median per cohort of 23.5 per cent. There were 7 perioperative deaths (0.7 per cent of 993 for whom mortality data were provided). The overall median survival ranged from 21 to 61.5 months, with 1 -, 3 -, and 5-year survival of 69.0% to 100%, 21.0% to 87.0%, and 25.0% to 87.0%, respectively. Conclusions: Repeat hepatectomy can be performed safely and is associated with long-term survival in a subset of patients with recurrent HCC. However, the findings have to be carefully interpreted due to the lower level of evidence. A randomized controlled study is needed to compare repeat hepatectomy and other modalities for recurrent HCC. Background Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, responsible for 500,000 deaths globally every year, and its incidence is increasing worldwide because of the dissemination of hepatitis B and C virus infection [1]. With advances in surgical techniques and perioperative care, results of hepatic resection for HCC have greatly improved. Nonetheless, the long-term survival after hepatectomy remains unsatisfactory because of the high incidence of recurrence. Intrahepatic recurrence are the most common and are seen in up to 68-96% of patients [2]. Thus, effective therapeutic strate* Correspondence: [email protected], [email protected] 3
Department of Molecular Oncology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China 2 Department of Special Treatment and Liver transplantation, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China † Contributed equally
gies of intrahepatic recurrence is critical in prolonging survival after resection of HCC. Transcatheter arterial chemoembolization (TACE) is most commonly used as a treatment modality for intrahepatic recurrence. However, the role of TACE therapy in the treatment of postoperative recurrence is pessimistic, with 5-year survival rates only range
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