Analysis Of Curative Effect Of Repeated Hepatectomy For Recurrent HCC

ObjectiveTo analyze and summarize the curative effect and related factors influencing the prognosis of recurrent HCC with repeated hepatectomy. And provide the reference to improve the prognosis of patients with recurrent HCC.MethodsThe clinical data of 28 patients of recurrent HCC with repeated hepatectomy who were coming from the same medical group in the department of hepatic and biliary pancreatic surgery in The First Affiliated Hospital of Zhejiang University between July 2011 and September 2015 were analyzed retrospectively. The median tumor-free survival time, tumor-free survival rate and the cumulative survival rate of the repeated hepatectomy were used to compare with the first hepatectomy and the RFA respectively in order to assess the efficacy of the repeated hepatectomy. Analysis of variance (ANOVA) was used to compare the amount of bleeding and operative time between the first and the second hepatectomy. To summarize and analyze the factors that affected the rate of tumor-free survival of patients with repeated hepatectomy.ResultsThe main surgical approach of the repeated hepatectomy was irregular resection. The duration of surgery had significant difference between the first and second hepatectomy (P<0.05). The amount of bleeding during the operation was not statistically significant (P>0.05). In the repeated hepatectomy, the median tumor-free survival time was 11 months (3 to 24 months) and the tumor-free survival rate of 1,3,5 year was 46.4%,0%,0%. In the initial hepatectomy, the median tumor-free survival time was 32 months (2 to 120 months) and the tumor-free survival rate of 1,3,5 year was 75.0%,35.7%,14.3%. The comparison was statistically significant between the initial and repeated hepatectomy (P<0.05). The TNM staging of patients treated with repeated hepatectomy was consistent with RFA, and in the repeated hepatectomy, the median tumor-free survival time was 14 months (4 to 24 months) and the tumor-free survival rate of 1,2,3 year was 60.7%,13.3%,0%. The median survival time was 50 months (19 to 108 months) and the cumulative survival rate of 1,3,5 year was 100.0%, 80.0%,26.7%. In the recurrent HCC treated with RFA, the median tumor-free survival time was 8 months (2 to 24 months) and the tumor-free survival rate of 1,2,3 year was 20.8%,4.2%,0%. The median survival time was 31 months (10 to 60 months) and the cumulative survival rate of 1,3,5 year was 91.7%,37.5%,4.2%. The comparison of the tumor-free survival rate in 1,2 year and the cumulative survival rate in 3,5 year was statistically significant between the repeated hepatectomy and RFA (P<0.05). The tumor-free survival time and the total survival time were also statistically significant between the repeated hepatectomy and RFA (P<0.05). By repeated hepatectomy, the comparison of the surgical options, tumor size and tumor capsule had statistically significant in the factors that affected the tumor-free survival rate in the first year (P<0.05). The comparison of the surgical options and the size of the tumor also had statistically significant in the factors that affected the tumor-free survival rate in the second year (P<0.05).ConclusionsRepeated hepatectomy for recurrent HCC could improve the tumor-free survival rate. The efficacy of repeated hepatectomy was better than the RFA. With the progression of the disease, the tumor-free survival time of the repeated hepatectomy was shorter than the first hepatectomy. Tumor size, tumor capsule and surgical options were the factors which influenced the tumor-free survival rate of repeated hepatectomy for recurrent HCC. Tumor diameter less than 5cm, tumor with intact capsule and radical resection were benefit to the postoperative prognosis of patients.