The largest western experience on salvage hepatectomy for recurrent hepatocellular carcinoma: propensity score-matched analysis on behalf of He.RC.O.Le.Study Group |
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| Institution: | 1. Department of General and Specialized Surgery, Division of General Surgery, Parma University Hospital, Parma, Italy;2. Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy;3. Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy;4. Division of Hepatobiliarypancreatic Surgery, IRCCS - Regina Elena National Cancer Institute, Rome, Italy;5. Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy;6. Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy;7. Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy;8. Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy;9. Department of Surgery, AOU Sant''Orsola Malpighi, IRCCS, Bologna, Italy;10. General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy;11. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy;12. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy;13. Department of Surgery, Monza Policlinic, Monza, Italy;14. Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy;15. Department of General Surgery, ASUGI, University Hospital of Trieste, Trieste, Italy;16. Department of General Surgery, ASST Crema, Crema, Italy;17. HPB Surgical Unit, San Paolo Hospital, Savona, Italy;18. Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy;19. Department of Surgery, L. Sacco Hospital, Milan, Italy;20. Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy;21. Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy;22. Hepatobiliary Surgery Division, Ospedale San Raffaele, Milano, Italy;23. Department of Surgery, Bolzano Central Hospital, Bolzano, Italy;24. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy;25. Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit - Treviso Hospital, Treviso, Italy;26. Department of Medical and Surgical Sciences, University of Bologna, Italy;27. Department of Surgery, San Gerardo Hospital, Monza, Italy;1. Department of General Surgery, Osan Hankook Hospital, 16, MilMeori-Ro 1 Beon-Gil, Osan-si, Gyeonggi-do, 18144, Republic of Korea;2. Biostatistics Collaboration Team, Research Core, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea;3. Center for Liver & Pancreato-biliary Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea;4. Department of Anesthesiology and Pain Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea;1. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan;2. Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Japan;3. Department of Hepatobiliary and Pancreatic Surgery, The Cancer Institute Hospital, Japan;4. Department of Surgery, National Defense Medical College, Japan;5. Department of Medical Oncology, Toranomon Hospital, Japan;6. Department of Digestive Surgery, Nihon University School of Medicine, Japan;7. Department of Surgery, NTT Medical Center Tokyo, Japan;8. Department of Surgery, National Center for Global-Health and Medicine, Japan;1. Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany;2. Institute of General and Surgical Pathology, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany;3. Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany;4. Department of Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany;1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA;2. Department of Surgery, Brigham and Women''s Hospital, Boston, MA, USA;3. Department of Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China;4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA;5. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA;1. Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan;2. Program in Liberal Medical Education (PLME) and the Department of Molecular Biology, Cell Biology & Biochemistry, Brown University, Providence, RI, USA;3. Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu County 300, Taiwan;1. Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway;2. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway;3. Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway;4. Institute of Clinical Medicine, University of Oslo, Norway;5. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway |
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| Abstract: | BackgroundWe aimed to evaluate, in a large Western cohort, perioperative and long-term oncological outcomes of salvage hepatectomy (SH) for recurrent hepatocellular carcinoma (rHCC) after primary hepatectomy (PH) or locoregional treatments.MethodsData were collected from the Hepatocarcinoma Recurrence on the Liver Study Group (He.RC.O.Le.S.) Italian Registry. After 1:1 propensity score-matched analysis (PSM), two groups were compared: the PH group (patients submitted to resection for a first HCC) and the SH group (patients resected for intrahepatic rHCC after previous HCC-related treatments).Results2689 patients were enrolled. PH included 2339 patients, SH 350. After PSM, 263 patients were selected in each group with major resected nodule median size, intraoperative blood loss and minimally invasive approach significantly lower in the SH group. Long-term outcomes were compared, with no difference in OS and DFS. Univariate and multivariate analyses revealed only microvascular invasion as an independent prognostic factor for OS.ConclusionSH proved to be equivalent to PH in terms of safety, feasibility and long-term outcomes, consistent with data gathered from East Asia. In the awaiting of reliable treatment-allocating algorithms for rHCC, SH appears to be a suitable alternative in patients fit for surgery, regardless of the previous therapeutic modality implemented. |
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