Annals of Surgical Oncology

, Volume 19, Issue 7, pp 2238–2245 | Cite as

Salvage Hepatectomy for Local Recurrent Hepatocellular Carcinoma After Ablation Therapy

  • Hiroyuki Sugo
  • Yoichi Ishizaki
  • Jiro Yoshimoto
  • Hiroshi Imamura
  • Seiji Kawasaki
Hepatobiliary Tumors



The results of salvage hepatectomy for local recurrent hepatocellular carcinoma after incomplete percutaneous ablation therapy are still unclear.


We conducted a retrospective analysis of 197 consecutive patients with hepatocellular carcinoma who underwent either salvage hepatectomy after prior incomplete percutaneous ablation therapy (salvage group; n = 23) or primary hepatectomy as the initial treatment (primary group; n = 174). The two groups were compared with respect to intraoperative data, operative mortality and morbidity, and long-term survival.


The salvage group showed a significantly longer operation time (385 vs. 300 min; P = 0.006) and a significantly greater intraoperative blood loss volume (402 vs. 265 ml; P = 0.024). The postoperative mortality rate was zero in both groups, and the morbidity rates were similar. Although the 1-, 3-, and 5-year disease-free survival rates after hepatectomy were significantly worse in the salvage group than in the primary group (65%, 41%, and 33% vs. 81%, 51%, and 45%, respectively; P = 0.031), the overall survival rates after hepatectomy did not differ significantly (91%, 91%, and 67% vs. 96%, 79%, and 65%, respectively; P = 0.790). The 1-, 3-, and 5-year overall survival and disease-free survival rates after percutaneous ablation therapy were also not different from those in the primary group (100, 96, and 83%, P = 0.115; and 96, 60, and 45%, P = 0.524, respectively).


The short-term and long-term results of salvage hepatectomy after incomplete percutaneous ablation therapy are equivalent to those of primary hepatectomy. Salvage hepatectomy is an acceptable treatment for patients with local recurrence of hepatocellular carcinoma after ablation therapy.


Local Recurrence Tace Primary Group Milan Criterion Tumor Regrowth 
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  1. 1.
    Bouza C, López-Cuadrado T, Alcázar R, Saz-Parkinson Z, Amate JM. Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol. 2009;9:31.PubMedCrossRefGoogle Scholar
  2. 2.
    Shiina S, Tagawa K, Nina Y, et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma in 146 patients. AJR Am J Roentgenol. 1993;160:1023–8.PubMedGoogle Scholar
  3. 3.
    Lencinoni RA, Allgaier HP, Cioin D, et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology. 2003;228:235–40.CrossRefGoogle Scholar
  4. 4.
    Harrison LE, Koneru B, Baramipour P, et al. Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma. J Am Coll Surg. 2003;197:759–64.PubMedCrossRefGoogle Scholar
  5. 5.
    Yin XY, Xie XY, Lu MD, et al. Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer. 2009;115:1914–23.PubMedCrossRefGoogle Scholar
  6. 6.
    Ishizaki Y, Yoshimoto J, Sugo H, Miwa K, Kawasaki S. Hepatectomy using traditional Péan clamp-crushing technique under intermittent Pringle maneuver. Am J Surg. 2008;196:353–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Terminology Committee of the International Hepato-Pancreato-Biliary Association. The Brisbane 2000 terminology of liver anatomy and resections. HBP Surg. 2000;2:333–9.Google Scholar
  8. 8.
    Le CC. Foie: etudes anatomiques et chirugicales. Paris: Masson & Cie; 1957.Google Scholar
  9. 9.
    Liver Cancer Study Group of Japan. The general rules for the clinical and pathological study of primary liver cancer. 5th ed. Tokyo: Kanehara-Syuppan; 1989 (in Japanese).Google Scholar
  10. 10.
    Dido D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefGoogle Scholar
  11. 11.
    N’Kontchou G, Mahamoudi A, Aout M, et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic in 235 Western patients with cirrhosis. Hepatology. 2009;50:1475–83.PubMedCrossRefGoogle Scholar
  12. 12.
    Waki K, Aikata H, Katamura Y, et al. Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: results and prognostic factors on long-term follow up. J Gastroenterol Hepatol. 2010;25:597–604.PubMedCrossRefGoogle Scholar
  13. 13.
    Zytoon AA, Ishii H, Murakami K, et al. Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome. Jpn J Clin Oncol. 2007;37:658–72.PubMedCrossRefGoogle Scholar
  14. 14.
    Kim YS, Rihm H, Cho OK, Koh BH, Kim Y. Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors. Eur J Radiol. 2006;59:432–41.PubMedCrossRefGoogle Scholar
  15. 15.
    Tateishi R, Shiina S, Teratani T, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer. 2005;103:1201–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Kei SK, Rhim H, Choi D, Lee WJ, Lim HK, Kim YS. Local tumor progression after radiofrequency ablation of liver tumors: analysis of morphologic pattern and site of recurrence. AJR Am J Roentgenol. 2008;190:1544–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Hori T, Nagata K, Hasuike S, et al. Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol. 2003;38:977–81.PubMedCrossRefGoogle Scholar
  18. 18.
    Fernandes ML, Lin CC, Lin CJ, Chen WT, Lin SM. Risk of tumor progression in early-stage hepatocellular carcinoma after radiofrequency ablation. Br J Surg. 2009;96:756–62.PubMedCrossRefGoogle Scholar
  19. 19.
    Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226:441–51.PubMedCrossRefGoogle Scholar
  20. 20.
    Livraghi T, Lazzaroni S, Meloni F, Solbiati L. Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Br J Surg. 2005;92:856–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Llovet JM, Vilana R, Brú C, et al. Barcelona Clinic Liver Cancer (BCLC) Group. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology. 2001;33:1124–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Lam VW, Ng KK, Chok KS, et al. Risk factors and prognostic factors of local recurrence after radiofrequency ablation of hepatocellular carcinoma. J Am Coll Surg. 2008;207:20–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Torzilli G, Del Fabbro D, Palmisano A, Marconi M, Makuuchi M, Montorsi M. Salvage hepatic resection after incomplete interstitial therapy for primary and secondary liver tumors. Br J Surg. 2007;94:208–13.PubMedCrossRefGoogle Scholar
  24. 24.
    Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary disease: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240:698–710.PubMedGoogle Scholar
  25. 25.
    Torzilli G, Makuuchi M, Inoue K, et al. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients. Arch Surg. 1999;134:984–92.PubMedCrossRefGoogle Scholar
  26. 26.
    Ikai I, Arii S, Okazaki M, et al. Report of the 17th Nationwide Follow-up Survey of Primary Liver Cancer in Japan. Hepatol Res. 2007;37:676–91.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Hiroyuki Sugo
    • 1
  • Yoichi Ishizaki
    • 1
  • Jiro Yoshimoto
    • 1
  • Hiroshi Imamura
    • 1
  • Seiji Kawasaki
    • 1
  1. 1.Department of Hepatobiliary-Pancreatic SurgeryJuntendo University School of MedicineTokyoJapan

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