Postoperative recurrence of hepatocellular carcinoma. Two hundred five consecutive patients who underwent hepatic resection in 15 years

M. F. Chen, T. L. Hwang, L. B. Jeng, C. S. Wang, Y. Y. Jan and S. C. Chen
Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.

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 wide-spread 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 alpha-fetoprotein levels were directly related to the length of time to recurrence (ie, the higher the serum alpha-fetoprotein level, the sooner the recurrence). CONCLUSIONS: The postoperative intrahepatic remnant rate is very high; 80% by 5 years after resection. The preoperative serum alpha-fetoprotein level and adequacy of the cut margin significantly influenced the recurrence rate.

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