Background and Objectives: Although radiofrequency ablation (RFA) is a well-established locoregional treatment modality for hepatocellular carcinoma (HCC), the optimal strategy to handle local recurrence after ablation is still debated. This study aims to investigate the role of salvage hepatectomy (SH) as a rescue therapy for recurrent HCC after RFA. Materials and Methods: Between January 2004 and December 2020, 1161 patients were subject to surgical resection for HCC. Among them, 47 patients who underwent SH for local recurrence after ablation were retrospectively analyzed and compared to a propensity score-matched group of controls (n = 47) who received primary hepatectomy (PH). Short-term and long-term outcomes were analyzed between the two groups. Results: After matching, operation time, intraoperative blood loss, postoperative hospital stay, and postoperative morbidity rates showed no statistically significant difference. Tumors in the SH group were associated with poor differentiation (SH 9 (19.1%) vs. PH 1 (2.1%),p< 0.001). The 5-year disease-free survival rates (31.6% vs. 73.4%,p< 0.001) and overall survival rates (80.3% vs. 94.2%,p= 0.047) were significantly lower in the SH group. In multivariable analysis, less extensive resection compared to the initial plan (hazard ratio (HR) 4.68,p= 0.024), higher grade (HR 5.38,P< 0.001), negative but close (<0.1 cm) resection margin (HR 22.14,p= 0.007), and R1 resection (HR 3.13,p= 0.006) were significant predictors for recurrence. Conclusions: SH for recurrent tumors after ablation showed safety and effectiveness equivalent to primary resection. As recurrent tumors show a higher grade and more aggressive behavior, more extensive resections with wide surgical margins are necessary to prevent recurrence.
背景与目的：尽管射频消融（RFA）已成为肝细胞癌（HCC）成熟的局部治疗手段，但消融后局部复发的最佳处理策略仍存争议。本研究旨在探讨挽救性肝切除术（SH）作为RFA后复发性HCC补救治疗的作用。材料与方法：2004年1月至2020年12月期间，共有1161例HCC患者接受手术切除。其中对47例因消融后局部复发接受SH治疗的患者进行回顾性分析，并与接受原发性肝切除术（PH）的倾向评分匹配对照组（n=47）进行比较。分析两组患者的短期及长期预后结果。结果：匹配后两组在手术时间、术中失血量、术后住院时间及术后并发症发生率方面均无统计学显著差异。SH组肿瘤分化程度较差（SH组9例（19.1%）对比PH组1例（2.1%），p<0.001）。SH组的5年无病生存率（31.6%对比73.4%，p<0.001）和总生存率（80.3%对比94.2%，p=0.047）显著较低。多变量分析显示，相较于初始计划的切除范围不足（风险比（HR）4.68，p=0.024）、肿瘤分级较高（HR 5.38，p<0.001）、切缘阴性但距离过近（<0.1厘米）（HR 22.14，p=0.007）以及R1切除（HR 3.13，p=0.006）是肿瘤复发的显著预测因素。结论：针对消融后复发肿瘤的SH治疗显示出与原发性肿瘤切除相当的安全性和有效性。由于复发肿瘤分级更高且更具侵袭性，需要实施更广泛的切除并保证足够的手术切缘以预防复发。
肿瘤(癌症)患者之家