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Intrahepatic recurrence of single nodular hepatocellular carcinoma after surgical resection: an analysis by segmental distribution
Author(s) -
Kim JinMin,
Lee SeungHyun,
Shin Woo Young,
Lee KeonYoung,
Kim Jun Mee,
Ahn SeungIk
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14824
Subject(s) - medicine , hepatocellular carcinoma , hepatectomy , resection , distribution (mathematics) , surgical resection , carcinoma , surgery , gastroenterology , mathematical analysis , mathematics
Background Intrahepatic recurrence is the major cause of management failure after surgical resection of hepatocellular carcinoma (HCC). In the present study, we analysed intrahepatic recurrence by HCC distribution using Couinaud's liver segments. Methods Recurrence proximity levels were defined with respect to primary tumour locations from Level LR (locoregional) to Level IV. Initial and recurrent tumours were compared with segmental distribution of their locations, and recurrence proximity levels were compared with initial tumour locations and disease‐free survival. Results Eighty‐five (58.2%) of 146 patients with single nodular HCC experienced intrahepatic recurrence after surgical resection with a mean disease‐free survival of 20.8 ± 21.1 months. Segmental distributions of initial and recurrent tumour locations were not significantly different ( P > 0.05), and both were similar to the normal segmental volume distribution except segments S5, S6 and S8. Recurrences in proximity levels LR to IV were 11.1%, 34.9%, 25.4%, 21.4%, and 7.1%, respectively, and this distribution agreed well with theoretical proximity level distribution ( P > 0.05). Disease‐free survivals for different recurrence levels were not different ( P = 0.530). Conclusion Intrahepatic recurrences after surgical resection of single nodular HCC occurred evenly in the remnant liver, and the timing was independent of the proximity between initial and recurrent tumours. Prevention was found to be proportional to the amount of liver segments removed. Surgical plans should take this into consideration.