Salvage hepatectomy for HCC recurrence after failed RFA, TACE or PEI: an unlock gateway to think of

Introduction: Outcomes of salvage hepatectomy for local recurrent hepatocellular carcinoma (HCC) after locoregional or percutaneous treatments are still unclear. Methods: We conducted a retrospective analysis of 92 consecutive patients with HCC who underwent either primary liver resection (group 1, 65/92) or salvage hepatectomy for recurrent HCC after failed percutaneous or locoregional treatments (group 2, 27/92). The two cohorts were compared in terms of perioperative mortality and morbidity and long-term disease-free and overall survival rates were analized. Results: Group 2 patients were previously submitted to a different range of treatments such as: RFA (17 cases), RFA + PEI (4 cases), TACE (4 cases), RFA + TACE (2 cases). HCC average size was comparable between group 1 and 2 (27.6 mm vs. 27.5 mm, respectively). In 6/60 (group 1) and 11/27 (group 2) liver resections were performed laparoscopically. Perioperative mortality rate was nihil in both groups and morbidity rate was comparable. The median progression-free survival was 16 months [CI 95% 12.3- 19.6] for group 1 and 43 months [CI 95% 22.5-63.4] for group 2 (p=0.013). The median overall survival was 68 months [CI 95% 32.4-103.5] for group 1 and 81 months [56-106.9] for group 2 (p=0.015). Conclusions: Salvage hepatectomy for HCC recurrence in patients not resected upfront, whose HCC relapsed after failure of loco-regional or percutaneous procedures, appears to be safe and effective. In our limited series, it provided optimal outcomes in terms of disease-free and overall long term survival, being a reasonable option in such patients.