Salvage hepatectomy for recurrence of hepatocellular carcinoma after radiofrequency ablation

Objective To investigate the safety and efficacy of salvage hepatectomy for recurrent hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Methods Clinical data of 6 patients with recurrent HCC after RFA undergoing salvage hepatectomy from January 2011 to December 2017 in the First People's Hospital of Foshan were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. All 6 patients were male, aged 40-62 years with a median age of 48 years. AFP was positive in 5 cases and negative in 1 case. Five patients were classified as Child-Pugh grade A and 1 case as grade B. The median indocyanine green retention rate at 15 min (ICGR15) was 0.06(0.03-0.08). The tumors were located in the left liver lobe in 1 case and in the right liver lobe in 5 cases. All patients underwent open salvage hepatectomy. Results All patients completed the operation successfully. The operation time was 270(240-300) min. The intraoperative blood loss was 312(100-550) ml. 4 patients presented with postoperative pleural effusion, and 2 of them were healed by pleural puncture and aspiration. 1 case suffering from esophageal and gastric varices rupture and bleeding was cured by endoscopic ligation. No perioperative death occurred. Pathological examination demonstrated that the tumor diameter was 4.5(2.0-8.3) cm. The tumor margin were observed active in 5 cases, the tumor center was active in 1 and microvascular invasion in 5. The follow-up time was 1-6 years with a median follow-up of 3 years. During the follow-up, 1 patient recurred after 6 years and underwent transarterial chemoembolisation (TACE). No tumor recurrence was found in other patients. Conclusion Salvage hepatectomy is an effective and safe treatment for recurrent HCC after RFA in patients with a good liver function reserve. Key words: Hepatectomy; Carcinoma, hepatocellular; Recurrence; Catheter ablation