Outcome and Quality of Life of Repeat Liver Resection for Intrahepatic Recurrence of Hepatocellular Carcinoma after Hepatectomy

Kenji Mizukami, Tutomu Takashima, Yuichi Arimoto, Yasuhisa Fujimoto, Masayuki Higashino and Masahiro Okuno

Department of Gastroenterological Surgery, Osaka City General Hospital

We evaluated clinicopathological factors, survival rate and quality of life (QOL) of repeat liver resection for intrahepatic recurrence of hepatocellular carcinoma (HCC) after hepatectomy. Of 153 patients who had radical hepatic resection during the past 15 yaers, 73 patients (48%) had intrahepatic tumor recurrence. Eighteen patients (25% of intrahepatic recurrences) received one or more hepatectomies for intrahepatic recurrence. Second, third and fourth hepatectomies were carried out on 13, two and three patients, respectively. Of these 18, there were 11 men and 7 women. Ages ranged from 55 to 76 years (mean 68 years). Their preoperative ICG-R15 values measured from 3% to 37% (mean 21%). The following operative procedures were performed more than subsegmentectomy, three, isolated entire caudate lobectomy, two, anatomical limited resection, 18, and nonanatomical wedge resection, two. The number of resected tumors per operation ranged from one to five (mean 1.8). The size of resected tumors measured from 0.7 cm to 4.4 cm (mean 2.0 cm) in diameter. Operation time was from 240 min to 660 min (mean 420 min). Blood loss volume ranged from 500 g to 4, 600 g (mean 1,470 g). Postoperative hospital stay ranged from 11 days to 50 days (mean 26 days). Only one operative death occured after a second hepatectomy due to drug induced shock, but all other patients were restored to good QOL. The 5-year survival rate after the second hepatectomy was 67% in these 18 patients, and was almost the same value in 50% of all 153 patients' 5-year survival rate after the first hepatectomy. The present study has shown that repeat hepatectomy for recurrent HCC can result in early recovery of QOL, improved long-term outcome and short hospital stay. Therefore, we think that repeat hepatectomy is the most effective procedure for resectable recurrent HCC.

Key words
intrahepatic recurrence of hepatocellular carcinoma after hepatectomy, repeat liver resection,
outcome and quality of life after repeat hepatectomy

Reprint requests
Kenji Mizukami Department of Gastroenterological Surgery, Osaka City General Hospital 2-53 Miyakojimahondori, Miyakojimaku, Osaka 534-0021 JAPAN

Accepted
January 27, 1999

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