Impact of Repeated Hepatectomy on Liver Regeneration in Hepatocellular Carcinoma: A Propensity Score-based Analysis

Background: Repeated hepatectomy is one of the most curative treatments for recurrent hepatocellular carcinoma (HCC). However, it is not clear whether the remnant liver has the same regenerative ability in repeated hepatectomy. This study assessed the regenerative ability of remnant liver after primary and secondary hepatectomy. Patients and Methods: This study retrospectively assessed 118 patients who underwent curative anatomical liver resection for HCC. The liver regeneration rate (LRR) was calculated by SYNAPSE-VINCENT based on dynamic computed tomography before and 1 month after liver resection. To reduce any bias, the patients were matched at a 2: 1 ratio by propensity score matching (PSM) method. Results: Before PSM, the laparoscopic radiofrequency-assisted liver resection (LRR) was higher in secondary hepatectomy than in primary (p=0.027). After PSM, there was no significant difference in LRR between the two groups (p=0.088). Among 10 patients who underwent both primary and secondary hepatectomy, there was no significant difference in LRR at both hepatectomies (p=0.80). Conclusion: Hepatic regenerative ability after secondary hepatectomy may not be inferior to that after primary hepatectomy.