According to results recently published in the Annals of Surgery, repeat surgery for recurrent liver cancer can provide long-term survival in a subset of patients.
The liver is the largest organ in the body and is responsible for over 500 functions, including the secretion of glucose, proteins, vitamins and fats; the production of bile; the processing of hemoglobin and detoxification of numerous substances. Primary liver cancer starts in the cells of the liver and can spread, through blood or lymph vessels, to different parts of the body. Approximately 85% of all liver cancers that start in the liver (primary liver cancer) are classified as hepatocellular carcinoma (HCC). Treatment may include surgery, radiation therapy, radiofrequency ablation, cryosurgery, immunotherapy, systemic or local chemotherapy or a combination of therapies. Currently, the only treatment option that appears to produce a cure for cancer in the liver is the surgical removal (resection) of the initial cancer. Data has indicated that surgical resection for a cancer recurrence within the liver in patients with HCC that had a previous resection is also a feasible option. However, it has not yet been established what disease and/or patient characteristics lend to optimal outcomes following more than one liver resection.
Recently, researchers from Japan conducted a study evaluating data of patients who underwent surgical resections of the liver (hepatectomy) for HCC between 1994 and 2000. This study involved 334 patients who underwent surgery for initial treatment of HCC, and 67 patients who underwent a second hepatectomy for recurrent HCC. Survival at 1, 3, and 5 years following an initial hepatectomy in the group of 334 patients was 94%, 75%, and 56%, respectively. Survival at 1, 3, and 5 years following a second hepatectomy in the group of 67 patients with recurrent HCC was 93%, 70%, and 56%, respectively. Overall, surgical time and blood loss were the same between initial hepatectomy and repeat hepatectomy. Upon analysis of several differing variables, researchers noted that patients with only one site of cancer upon initial diagnosis, those were cancer-free for at least one year following the initial hepatectomy, and those whose cancer did not spread to the portal vein (large vein in the liver) had the best prognosis following a repeat hepatectomy. Of the 29 patients who underwent a repeat hepatectomy and met these 3 criteria, 3 and 5-year survival rates following the repeat hepatectomy were 100% and 86%, respectively. In addition, researchers evaluated a group of 11 patients who had undergone a 3rd hepatectomy, and a group of 6 patients who had undergone a 4th hepatectomy. At approximately 2.5 years following the 3rd hepatectomy and 1.4 years following the 4th hepatectomy, all of these patients are still alive.
These researchers concluded that a repeat hepatectomy appears to be the optimal treatment option for patients with recurrent HCC in the liver, particularly for those with only one site of initial cancer, those who were cancer-free following initial hepatectomy for at least one year, and those with no cancer spread to the portal vein. Patients who have recurrent HCC may wish to speak with their physician about the risks and benefits of a 2nd hepatectomy, or the participation in a clinical trial evaluating novel therapeutic options.
Reference: Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma.
Annals of Surgery. 2003; 238(5):703-710.
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