Rationale of surgical management for recurrent hepatocellular carcinoma.

From 1979 to 1991, 100 patients with hepatocellular carcinoma (HCC) underwent a curative hepatic resection in our institution. Five patients died within 1 month, and four patients died after longer than 1 month hospitalization. The remaining 91 patients were closely followed. Intrahepatic recurrences became obvious in 36 (40%) of these 91 patients during the follow-up period. Second operation was carried out on 22 patients, and the re-extirpation of HCCs was performed on 16 patients. Pure ethanol injection into the tumor associated with implantation of the Infuse-A-Port (Infusaid Inc., Norwood, MA) for intra-arterial infusion of anti-cancer agents was performed on the remaining six patients. Of these 22 patients, 15 are still alive, eight being free of HCC and seven with the disease, for 13 to 92 months after the first operation. The cumulative survival rate of 22 patients with repeated operations was significantly better than that of 14 patients who were treated conservatively (p < 0.05). The adequate surgical management of recurrent HCC is considered as most important in achieving better prognosis of HCC.