Influence factors to recurrence of hepatocellular carcinoma after surgical resection

Objective: To analyze the influence factors to recurrence of hepatocellular carcinoma (HHC) after its resection according to pathologic findings of the resected primary tumor and angiographic features of the recurrence tumor. Methods: In this series, 142 cases with recurrence HCC were analyzed with respect to (1) size, number, gross and histologic findings of the primary tumor; (2) time when recurrence occurred; (3) size, number, blood supply, staining property, and accumulation of lipiodol oil in the recurrence tumor. Following angiography, arterial chemoembolization was performed. Results: In 101 of the 142 (71.1%) cases, the primary tumor was>5 cm in diameter, and in 41 cases (28.9%) it was <5 cm. In 67.7% of the cases, the capsule of the primary tumor was incomplete or absent. In 67.7% of the cases, the capsule of the primary tumor was incomplete or absent. In 47 cases (33.1%), satellite tumor nodules were seen during operation but they were seen on pathologic sections in 94 cases (66.2%). Tumor thrombus was present in the portal vein in 26 cases (18.3%) during operation and 121 cases (85.2%) on pathologic examination, respectively. In the majority of the cases (99/142), recurrence had occurred within 6 months after operation. The recurrence fool consisted of multiple tumor nodules of <5 cm in 68.3% of the cases. On angiography, the recurrence tumors were rich in blood supply and with good accumulation of lipiodol after embolization. Conclusion: Recurrence is apt to occur in HCC patients with large (>5cm) primary tumor which has incomplete or no capsule, with satellite tumor nodules and protal vein tumor thrombus. It is suggested to perform angiography 1-2 months after surgery to detect early recurrrence and, if confirmed, the patients may be treated by trans-catheter arterial chemoembolization.