Liver Resection Versus Embolization for Recurrent Hepatocellular Carcinoma

  • Yutaka MidorikawaEmail author
  • Tadatoshi Takayama
  • Masamichi Moriguchi
  • Rempei Yagi
  • Shunsuke Yamagishi
  • Hisashi Nakayama
  • Osamu Aramaki
  • Shintaro Yamazaki
  • Shingo Tsuji
  • Tokio Higaki
Original Scientific Report



Despite curative resection, hepatocellular carcinoma (HCC) has a high probability of recurrence. We validated the potential role of liver resection (LR) for recurrent HCC.


Patients with intrahepatic recurrence with up to three lesions were included. We compared survival times of patients undergoing their first LR to those of patients undergoing repeated LR. Then, survival times of the patients who had undergone LR and transcatheter chemoembolization (TACE) for recurrent HCC after propensity score matching were compared.


After a median follow-up period of 3.1 years (range, 0.2–16.3), median overall survival times were 6.5 years (95% CI 6.0–7.0), 5.7 years (5.2–6.2), and 5.1 years (4.9–7.3) for the first LR (n = 1234), second LR (n = 273), and third LR (n = 90) groups, respectively. Severe complications frequently occurred in the first LR group (p = 0.059). Operative times were significantly longer for the third LR group (p = 0.012). After the first recurrence, median survival times after one-to-one pair matching were 5.7 years (95% CI 4.5–6.5) and 3.1 years (2.1–3.8) for the second LR group (n = 146) and TACE group (n = 146), respectively (p < 0.001). The median survival time of the third LR group (n = 41) (6.2 years; 95% CI 3.7–NA) was also longer than that of TACE group (n = 41) (3.4 years; 1.8–4.5; p = 0.010) after the second recurrence.


Repeated LR for recurrent HCC is the procedure of choice if there are three or fewer tumors.



This research was supported by AMED under Grant Number JP18hk0102049 and a Grants-in-aid of the 106th Annual Congress of JSS Memorial Surgical Research Fund, Tokyo, Japan.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest to declare.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Yutaka Midorikawa
    • 1
    Email author
  • Tadatoshi Takayama
    • 1
  • Masamichi Moriguchi
    • 1
  • Rempei Yagi
    • 1
  • Shunsuke Yamagishi
    • 1
  • Hisashi Nakayama
    • 1
  • Osamu Aramaki
    • 1
  • Shintaro Yamazaki
    • 1
  • Shingo Tsuji
    • 2
  • Tokio Higaki
    • 1
  1. 1.Department of Digestive SurgeryNihon University School of MedicineTokyoJapan
  2. 2.Genome Science Division, Research Center for Advanced Science and TechnologyUniversity of TokyoTokyoJapan

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