Current status and progress in the surgical treatment of recurrent hepatocellular carcinoma_West China Medical Journal

Authors：

CHEN Yanyu , ZHANG Xiaoyun , LI Chuan ,  WEN Tianfu

Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WEN Tianfu, Email: wentianfu@scu.edu.cn

Keywords：

Recurrent hepatocellular carcinoma; Hepatectomy; Liver transplantation; Radiofrequency ablation; Transcatheter arterial chemoembolization

DOI：

10.7507/1002-0179.201904043

Video：

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The treatment of liver cancer is still a challenge in the world, and it is mainly refers to hepatocellular carcinoma (HCC). There are many factors affecting the overall survival rate of HCC; the recurrence of HCC is the main risk factor affecting the survival of patients, hence, it is urgent to explore the clinical treatment of recurrent HCC to obtain long-term survival of the patients. Up to now, surgical treatment is a radical treatment for HCC. Similarly, liver resection and liver transplantation are still the main therapy methods for recurrent HCC. In addition, radiofrequency ablation and transcatheter arterial chemoembolization and other local treatments still play an irresistible role. Therefore, emphasizing the postoperative follow-up of patients, diagnosing recurrent HCC in early stage, paying attention to the risk factors of HCC recurrence and selecting a suitable treatment plan for individuals are critical ways to prolong the survival of patients.

Citation： CHEN Yanyu, ZHANG Xiaoyun, LI Chuan, WEN Tianfu. Current status and progress in the surgical treatment of recurrent hepatocellular carcinoma. West China Medical Journal, 2019, 34(6): 688-692. doi: 10.7507/1002-0179.201904043 Copy

1.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2.	中华人民共和国国家卫生和计划生育委员会. 原发性肝癌诊疗规范(2017年版). 临床肝胆病杂志, 2017, 33(8): 1419-1431.
3.	Ng IO, Guan XY, Poon RT, et al. Determination of the molecular relationship between multiple tumour nodules in hepatocellular carcinoma differentiates multicentric origin from intrahepatic metastasis. J Pathol, 2003, 199(3): 345-353.
4.	四川大学华西医院肝癌MDT团队, 文天夫. 肝细胞癌切除术后复发转移的防治: 华西医院多学科专家共识. 中国普外基础与临床杂志, 2017, 24(8): 927-939.
5.	Eguchi S, Kanematsu T, Arii S, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery, 2008, 143(4): 469-475.
6.	向邦德, 黎乐群, 赵荫农, 等. 复发性肝癌再切除术患者预后因素分析. 中国肿瘤临床, 2010, 37(17): 994-997.
7.	Nobuoka D, Kato Y, Gotohda N, et al. Postoperative serum alpha-fetoprotein level is a useful predictor of recurrence after hepatectomy for hepatocellular carcinoma. Oncol Rep, 2010, 24(2): 521-528.
8.	Liu Y, Wang ZX, Cao Y, et al. Preoperative inflammation-based markers predict early and late recurrence of hepatocellular carcinoma after curative hepatectomy. Hepatobiliary Pancreat Dis Int, 2016, 15(3): 266-274.
9.	Matsuda M, Fujii H, Kono H, et al. Surgical treatment of recurrent hepatocellular carcinoma based on the mode of recurrence: repeat hepatic resection or ablation are good choices for patients with recurrent multicentric cancer. J Hepatobiliary Pancreat Surg, 2001, 8(4): 353-359.
10.	Poon RT, Fan ST, Ng IO, et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer, 2000, 89(3): 500-507.
11.	Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology, 1997, 26(5): 1176-1181.
12.	Shirabe K, Shimada M, Gion T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg, 1999, 188(3): 304-309.
13.	Siriwardana RC, Lo CM, Chan SC, et al. Role of portal vein embolization in hepatocellular carcinoma management and its effect on recurrence: a case-control study. World J Surg, 2012, 36(7): 1640-1646.
14.	Lee KT, Wang SN, Su RW, et al. Is wider surgical margin justified for better clinical outcomes in patients with resectable hepatocellular carcinoma?. J Formos Med Assoc, 2012, 111(3): 160-170.
15.	Liu K, Chen Y, Wu X, et al. Laparoscopic liver re-resection is feasible for patients with posthepatectomy hepatocellular carcinoma recurrence: a propensity score matching study. Surg Endosc, 2017, 31(11): 4790-4798.
16.	Yamashita Y, Yoshida Y, Kurihara T, et al. Surgical results for recurrent hepatocellular carcinoma after curative hepatectomy: repeat hepatectomy versus salvage living donor liver transplantation. Liver Transpl, 2015, 21(7): 961-968.
17.	Yong CC, Tsai MC, Lin CC, et al. Comparison of salvage living donor liver transplantation and local regional therapy for recurrent hepatocellular carcinoma. World J Surg, 2016, 40(10): 2472-2480.
18.	Zhang X, Li C, Wen T, et al. Treatment for intrahepatic recurrence after curative resection of hepatocellular carcinoma: salvage liver transplantation or re-resection/radiofrequency ablation? A retrospective cohort study. Int J Surg, 2017, 46: 178-185.
19.	Chan AC, Chan SC, Chok KS, et al. Treatment strategy for recurrent hepatocellular carcinoma: salvage transplantation, repeated resection, or radiofrequency ablation?. Liver Transpl, 2013, 19(4): 411-419.
20.	Hu Z, Zhou J, Li Z, et al. Time interval to recurrence as a predictor of overall survival in salvage liver transplantation for patients with hepatocellular carcinoma associated with hepatitis B virus. Surgery, 2015, 157(2): 239-248.
21.	Kaido T, Mori A, Ogura Y, et al. Living donor liver transplantation for recurrent hepatocellular carcinoma after liver resection. Surgery, 2012, 151(1): 55-60.
22.	Guerrini GP, Gerunda GE, Montalti R, et al. Results of salvage liver transplantation. Liver Int, 2014, 34(6): e96-e104.
23.	张英才, 覃伟, 杨扬. 复发性肝癌行补救性肝移植的疗效. 肝胆外科杂志, 2014, 22(2): 87-89.
24.	郑树森, 徐骁, 陈峻, 等. 中国肝癌肝移植临床实践指南(2018版). 临床肝胆病杂志, 2019, 35(2): 275-280.
25.	朱继领, 张克瑞. 射频消融与再手术治疗符合米兰标准的术后复发性肝癌的Meta分析. 中国普通外科杂志, 2017, 26(7): 838-846.
26.	刘嘉龙, 黄登, 曹利, 等. 腹腔镜肝切除术和射频消融术治疗复发性肝癌的前瞻性随机对照研究(中期随访分析). 第三军医大学学报, 2019, 41(5): 467-472.
27.	步向阳, 陈斌, 李洪, 等. 根治性切除术后复发性小肝癌射频消融与手术切除的疗效比较. 临床普外科电子杂志, 2014, 2(3): 23-25.
28.	段纪成, 刘凯, 吴孟超, 等. 经皮肝穿刺射频消融与再次肝切除对复发性小肝癌的随机对照研究. 肝胆外科杂志, 2015, 23(1): 15-17.
29.	方河清, 唐喆, 何敏志. 射频消融在复发性肝癌治疗中的应用. 肝胆外科杂志, 2012, 20(4): 246-247.
30.	吴飞翔, 王方为, 马良, 等. 原发性肝癌术后复发246例再治疗的近期疗效. 中国癌症防治杂志, 2012, 4(2): 167-170.
31.	Koh PS, Chan AC, Cheung TT, et al. Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis. HPB (Oxford), 2016, 18(1): 72-78.
32.	沈锋, 奚韬. 肝癌切除术后抗复发治疗. 中国实用外科杂志, 2008, 28(12): 1029-1031.
33.	Jin YJ, Lee JW, Lee OH, et al. Transarterial chemoembolization versus surgery/radiofrequency ablation for recurrent hepatocellular carcinoma with or without microvascular invasion. J Gastroenterol Hepatol, 2014, 29(5): 1056-1064.
34.	范利斌. 经肝动脉化疗栓塞术联合射频消融术治疗原发性肝癌的临床疗效. 临床合理用药杂志, 2016, 9(36): 113-114.
35.	李鹏, 周丁华, 吕伟, 等. TACE联合高强度聚焦超声治疗中晚期肝癌的临床研究. 中国现代普通外科进展, 2013, 16(11): 870-874.
36.	水永杰, 魏启春. 肝脏肿瘤的立体定向放射治疗. 实用肿瘤杂志, 2018, 33(2): 107-111.
37.	孟剑, 姜凤元, 王东艳, 等. 经皮微波固化对肝内大血管旁复发性肝癌的疗效及安全性. 现代生物医学进展, 2016, 16(30): 5974-5976.
38.	Sun HC, Tang ZY, Wang L, et al. Postoperative interferon alpha treatment postponed recurrence and improved overall survival in patients after curative resection of HBV-related hepatocellular carcinoma: a randomized clinical trial. J Cancer Res Clin Oncol, 2006, 132(7): 458-465.
39.	He C, Peng W, Li C, et al. Thymalfasin, a promising adjuvant therapy in small hepatocellular carcinoma after liver resection. Medicine (Baltimore), 2017, 96(16): e6606.

1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. 中华人民共和国国家卫生和计划生育委员会. 原发性肝癌诊疗规范(2017年版). 临床肝胆病杂志, 2017, 33(8): 1419-1431.
3. Ng IO, Guan XY, Poon RT, et al. Determination of the molecular relationship between multiple tumour nodules in hepatocellular carcinoma differentiates multicentric origin from intrahepatic metastasis. J Pathol, 2003, 199(3): 345-353.
4. 四川大学华西医院肝癌MDT团队, 文天夫. 肝细胞癌切除术后复发转移的防治: 华西医院多学科专家共识. 中国普外基础与临床杂志, 2017, 24(8): 927-939.
5. Eguchi S, Kanematsu T, Arii S, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery, 2008, 143(4): 469-475.
6. 向邦德, 黎乐群, 赵荫农, 等. 复发性肝癌再切除术患者预后因素分析. 中国肿瘤临床, 2010, 37(17): 994-997.
7. Nobuoka D, Kato Y, Gotohda N, et al. Postoperative serum alpha-fetoprotein level is a useful predictor of recurrence after hepatectomy for hepatocellular carcinoma. Oncol Rep, 2010, 24(2): 521-528.
8. Liu Y, Wang ZX, Cao Y, et al. Preoperative inflammation-based markers predict early and late recurrence of hepatocellular carcinoma after curative hepatectomy. Hepatobiliary Pancreat Dis Int, 2016, 15(3): 266-274.
9. Matsuda M, Fujii H, Kono H, et al. Surgical treatment of recurrent hepatocellular carcinoma based on the mode of recurrence: repeat hepatic resection or ablation are good choices for patients with recurrent multicentric cancer. J Hepatobiliary Pancreat Surg, 2001, 8(4): 353-359.
10. Poon RT, Fan ST, Ng IO, et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer, 2000, 89(3): 500-507.
11. Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology, 1997, 26(5): 1176-1181.
12. Shirabe K, Shimada M, Gion T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg, 1999, 188(3): 304-309.
13. Siriwardana RC, Lo CM, Chan SC, et al. Role of portal vein embolization in hepatocellular carcinoma management and its effect on recurrence: a case-control study. World J Surg, 2012, 36(7): 1640-1646.
14. Lee KT, Wang SN, Su RW, et al. Is wider surgical margin justified for better clinical outcomes in patients with resectable hepatocellular carcinoma?. J Formos Med Assoc, 2012, 111(3): 160-170.
15. Liu K, Chen Y, Wu X, et al. Laparoscopic liver re-resection is feasible for patients with posthepatectomy hepatocellular carcinoma recurrence: a propensity score matching study. Surg Endosc, 2017, 31(11): 4790-4798.
16. Yamashita Y, Yoshida Y, Kurihara T, et al. Surgical results for recurrent hepatocellular carcinoma after curative hepatectomy: repeat hepatectomy versus salvage living donor liver transplantation. Liver Transpl, 2015, 21(7): 961-968.
17. Yong CC, Tsai MC, Lin CC, et al. Comparison of salvage living donor liver transplantation and local regional therapy for recurrent hepatocellular carcinoma. World J Surg, 2016, 40(10): 2472-2480.
18. Zhang X, Li C, Wen T, et al. Treatment for intrahepatic recurrence after curative resection of hepatocellular carcinoma: salvage liver transplantation or re-resection/radiofrequency ablation? A retrospective cohort study. Int J Surg, 2017, 46: 178-185.
19. Chan AC, Chan SC, Chok KS, et al. Treatment strategy for recurrent hepatocellular carcinoma: salvage transplantation, repeated resection, or radiofrequency ablation?. Liver Transpl, 2013, 19(4): 411-419.
20. Hu Z, Zhou J, Li Z, et al. Time interval to recurrence as a predictor of overall survival in salvage liver transplantation for patients with hepatocellular carcinoma associated with hepatitis B virus. Surgery, 2015, 157(2): 239-248.
21. Kaido T, Mori A, Ogura Y, et al. Living donor liver transplantation for recurrent hepatocellular carcinoma after liver resection. Surgery, 2012, 151(1): 55-60.
22. Guerrini GP, Gerunda GE, Montalti R, et al. Results of salvage liver transplantation. Liver Int, 2014, 34(6): e96-e104.
23. 张英才, 覃伟, 杨扬. 复发性肝癌行补救性肝移植的疗效. 肝胆外科杂志, 2014, 22(2): 87-89.
24. 郑树森, 徐骁, 陈峻, 等. 中国肝癌肝移植临床实践指南(2018版). 临床肝胆病杂志, 2019, 35(2): 275-280.
25. 朱继领, 张克瑞. 射频消融与再手术治疗符合米兰标准的术后复发性肝癌的Meta分析. 中国普通外科杂志, 2017, 26(7): 838-846.
26. 刘嘉龙, 黄登, 曹利, 等. 腹腔镜肝切除术和射频消融术治疗复发性肝癌的前瞻性随机对照研究(中期随访分析). 第三军医大学学报, 2019, 41(5): 467-472.
27. 步向阳, 陈斌, 李洪, 等. 根治性切除术后复发性小肝癌射频消融与手术切除的疗效比较. 临床普外科电子杂志, 2014, 2(3): 23-25.
28. 段纪成, 刘凯, 吴孟超, 等. 经皮肝穿刺射频消融与再次肝切除对复发性小肝癌的随机对照研究. 肝胆外科杂志, 2015, 23(1): 15-17.
29. 方河清, 唐喆, 何敏志. 射频消融在复发性肝癌治疗中的应用. 肝胆外科杂志, 2012, 20(4): 246-247.
30. 吴飞翔, 王方为, 马良, 等. 原发性肝癌术后复发246例再治疗的近期疗效. 中国癌症防治杂志, 2012, 4(2): 167-170.
31. Koh PS, Chan AC, Cheung TT, et al. Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis. HPB (Oxford), 2016, 18(1): 72-78.
32. 沈锋, 奚韬. 肝癌切除术后抗复发治疗. 中国实用外科杂志, 2008, 28(12): 1029-1031.
33. Jin YJ, Lee JW, Lee OH, et al. Transarterial chemoembolization versus surgery/radiofrequency ablation for recurrent hepatocellular carcinoma with or without microvascular invasion. J Gastroenterol Hepatol, 2014, 29(5): 1056-1064.
34. 范利斌. 经肝动脉化疗栓塞术联合射频消融术治疗原发性肝癌的临床疗效. 临床合理用药杂志, 2016, 9(36): 113-114.
35. 李鹏, 周丁华, 吕伟, 等. TACE联合高强度聚焦超声治疗中晚期肝癌的临床研究. 中国现代普通外科进展, 2013, 16(11): 870-874.
36. 水永杰, 魏启春. 肝脏肿瘤的立体定向放射治疗. 实用肿瘤杂志, 2018, 33(2): 107-111.
37. 孟剑, 姜凤元, 王东艳, 等. 经皮微波固化对肝内大血管旁复发性肝癌的疗效及安全性. 现代生物医学进展, 2016, 16(30): 5974-5976.
38. Sun HC, Tang ZY, Wang L, et al. Postoperative interferon alpha treatment postponed recurrence and improved overall survival in patients after curative resection of HBV-related hepatocellular carcinoma: a randomized clinical trial. J Cancer Res Clin Oncol, 2006, 132(7): 458-465.
39. He C, Peng W, Li C, et al. Thymalfasin, a promising adjuvant therapy in small hepatocellular carcinoma after liver resection. Medicine (Baltimore), 2017, 96(16): e6606.

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