Surgical results for recurrent hepatocellular carcinoma after curative hepatectomy: Repeat hepatectomy versus salvage living donor liver transplantation

The aims of this study were to evaluate the efficacy of repeat hepatectomy (Hx) and salvage living donor liver transplantation (LDLT) for recurrent hepatocellular carcinoma (HCC). A retrospective cohort study was performed to analyze the surgical results of repeat Hx and salvage LDLT for patients with recurrent HCC within the Milan criteria from 1989 to 2012. A total of 159 patients were divided into 2 groups: a repeat Hx group (n=146) and a salvage LDLT group (n=13). Operative results and patient prognoses were compared between the 2 groups. The operative invasiveness, including the operation time (229.1 +/- 97.7 versus 862.9 +/- 194.4 minutes; P<0.0001) and blood loss (596.3 +/- 764.9 versus 24,690 +/- 59,014.4 g; P<0.0001), were significantly higher in the salvage LDLT group. The early surgical results, such as morbidity (31% versus 62%; P=0.0111) and the duration of hospital stay (20 +/- 22 versus 35 +/- 21 days; P=0.0180), were significantly worse in the salvage LDLT group. There was no significant difference in the overall survival (OS) rate, but the disease-free survival rate of the salvage LDLT group was significantly better (P=0.0002). The OS rate of patients with grade B liver damage in the repeat Hx group was significantly worse (P<0.0001), and the 5-year OS rate was quite low, that is, 20% (liver damage A, 77% for the repeat Hx group and 75% for the salvage LDLT group). The prognosis of patients with grade B liver damage after repeat Hx for recurrent HCC is poor, and salvage LDLT would be a potent option for such patients. Liver Transpl 21:961-968, 2015. (c) 2015 AASLD.