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Comment & Response
March 20, 2019

Care After Liver Resection for Hepatocellular Carcinoma

Author Affiliations
  • 1Department of Surgery, City of Hope National Medical Center, Duarte, California
JAMA Surg. 2019;154(6):567. doi:10.1001/jamasurg.2019.0147

To the Editor The current practice of surveillance after potentially curative cancer treatment is based more on biases than on scientific evidence. Poorly justified follow-up tests add time burden for patients, anticipatory anxiety while waiting for results, and cost and increase radiation exposure.1 We read with interest the article by Xu et al,2 which provides important information for guiding follow-up of patients after resection of hepatocellular carcinoma. This large multicenter study documents a clear shift in recurrence patterns after 2 years of follow-up. Early recurrence can occur in liver, lung, bone, and other systemic sites. After 2 years, 90% of recurrences occur in the liver.2 These results would suggest that a patient with normal α-fetoprotein levels and normal findings on computed tomography at 2 years follow-up could undergo sonography as the sole modality in late follow-up. In fact, these data would encourage a trial of sonography alone vs much more complex follow-up regimens.1

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