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July 1994

Postoperative Recurrence of Hepatocellular CarcinomaTwo Hundred Five Consecutive Patients Who Underwent Hepatic Resection in 15 Years

Author Affiliations

From the Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.

Arch Surg. 1994;129(7):738-742. doi:10.1001/archsurg.1994.01420310070012

Objectives:  To report the results of our investigation of the postoperative intrahepatic recurrent rates and the patterns of recurrence and to determine the factors that influenced these patterns of recurrence.

Design:  Case series.

Setting:  Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.

Patients:  Between 1977 and 1991, 162 men and 43 women with hepatocellular carcinoma underwent hepatic resection.

Results:  The surgical mortality rate was 4.4%. Of the 196 patients who were discharged from the hospital, 114 have since died and 20 were not available for follow-up. The overall cumulative recurrent rates for the last 5 years (1987 through 1991) were 59.7%, 65.0%, 76.5%, 77.0%, and 79.7%, respectively. Eighty patients experienced intrahepatic recurrence. Of these, 21 (26.2%) had recurrence near the resected stump, 43 (53.8%) had a single nodular recurrence in the remnant liver, and 16 (20%) had widespread multinodular recurrence. The patients with resected margins of less than 1 cm in diameter had relatively higher recurrence rates than those with resected margins of greater than 1 cm in diameter. All recurrences were noted within 3 years of the resection. The preoperative serum α-fetoprotein levels were directly related to the length of time to recurrence (ie, the higher the serum α-fetoprotein level, the sooner the recurrence).

Conclusions:  The postoperative intrahepatic remnant rate is very high; 80% by 5 years after resection. The preoperative serum α-fetoprotein level and adequacy of the cut margin significantly influenced the recurrence rate.(Arch Surg. 1994;129:738-742)