Aggressive multimodality treatment for intra-hepatic recurrence of hepatocellular carcinoma following hepatic resection.

Background: Intra-hepatic recurrence following hepatic resection is the primary challenge for patients with hepatocellular carcinoma (HCC). The aim of this investigation was to evaluate the long-term results of multimodality treatment of patients with intra-hepatic recurrent HCC following hepatic resection. Methods: From January 1995 through December 2001, a total of 846 patients who underwent hepatic resection for primary HCC at the Chang Gung Memorial Hospital (Taoyuan, Taiwan) were analyzed through long-term follow-up; intra-hepatic recurrence of HCC was identified in 444 (52.5%) patients. Patients with intra-hepatic recurrence were categorized into two groups based on whether they underwent regional treatment. A comparison analysis of the survival rates of these two groups following treatment for recurrent intra-hepatic HCC was performed. Results: Patients treated with multiple modalities exhibited significantly better survival results, both after initial hepatectomy and intra-hepatic recurrence compared with patients in the non-regional-treatment group. (p < 0.001) The 1-, 3-, and 5-year survival rates of patients in the regional-treatment group after initial hepatic resection were 88.1%, 60.1%, and 35.8%, respectively. The 1-, 3-, 5-year survival rates after treatment of intra-hepatic recurrence in the regional-treatment group were 74.8%, 39.3%, and 25.2%, respectively. Conclusion: The incidence of intra-hepatic recurrence following hepatic resection for HCC remains high. Aggressive multimodality treatment could extend the survival for patients with recurrent postoperative intra-hepatic HCC. (Chang Gung Med J 2005;28:543-50)