Management Of Intrahepatic Recurrence after Surgical Resection of Primary Hepatic Malignancy

Lim, Dae Sik; Park, Young Jin; Shin, Dong Hoon; Yoon, Mung Hi; Lee, Chung Han; Park, Young Hoon

Abstract

BACKGROUND: Surgical resection is generally accepted as the first choice of treatment for primary hepatic malignancy. But liver resection of primary hepatic malignancy is associated with a high incidence of recurrence, that has a poor prognosis. The goal of this research was to assess the rationale and result of treatment of recurrence following resection of primary hepatic malignancy. PATIENTS & METHODS: This was a retrospective study of 258 patients who had done hepatic resection with primary hepatic malignancy from 1990. Jan to 1999. Dec. And retrospective analysis of 72 patients with recurrent intrahepatic malignancy after hepatic resection. We exclude extrahepatic recurrence. The treatment methods of intrahepatic recurrence are variable. They include repeated hepatic resection, transcatheter arterial chemoembolization, percutaneous injection therapy of alcohol or hot saline, holmium-166 injection therapy, systemic chemotherapy and combined therapy.
RESULTS
The cases of hepatic re-resection are 8, the cases of transcatheter arterial chemoembolization are 19, the cases of percutaneous injection therapy of alcohol or hot saline are 7, the cases of holmium- 166 injection therapy are 6, the cases of systemic chemotherapy are 13 and the cases of combined therapy are 13. In the poor general condition, 6 patients, only conservative therapy was applied. The survival rate of 72 patients with recurrent intrahepatic malignancy after hepatic resection is 61.6%, 46.6%, 33.5%, 26.9%, 15.5%, 2.7% at 3 month, 6 month, 9month, 1year, 2year, 3year. The survival rate of the cases of hepatic re-resection is 100%, 85.7%, 71.4%, 71.4%, 47.6%. The survival rate of transcatheter arterial chemoembolization is 89.5%, 73.0%, 61.8%, 61.8%, 44.1%. 11.0%. The survival rate of percutaneous injection therapy of alcohol or hot saline is 100%, 71.4%, 42.9%, 42.9%, 14.3%, 0%. The survival rate of holmium-166 injection therapy is 66.7%, 66.7%, 66.7%, 33.3%, 33.3%. The survival rate of systemic chemotherapy is 53.9%, 38.5%, 30.8%, 15.4%, 15.4%, 0%. The survival rate of combined therapy is 100%, 84.6%, 69.2%, 69.2%, 41.5%, 0%. And the survival rate of conservative therapy is 54.1%, 39.8%, 19.9%, 14.2%, 7.6%, 3.8%.
CONCLUSION
We got results that the hepatic resection, holmium-166 injection therapy, and transcatheter arterial chemoembolization combined therapy were better than systemic chemotherapy and percutaneous injection therapy of alcohol or hot saline in longterm survival rate.