Clinical impact of rescue hepatectomy for local recurrence of hepatocellular carcinoma after radiofrequency ablation or selective transarterial chemoembolization

Background Local recurrence of hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) or selective transarterial chemoembolization (sTACE) is relatively common. This study aimed to examine rescue hepatectomy as a treatment of such recurrences. Methods We retrospectively analyzed 382 patients who underwent up-front hepatectomy for treatment of HCC and 44 patients who underwent rescue hepatectomy for treatment of local recurrence after RFA or sTACE. Propensity score matching analysis was performed to account for group differences. Results Mean time between the initial treatment and rescue hepatectomy was 3.5 ± 3.0 years. At the time of rescue hepatectomy, macroscopic vessel invasion was present in 15 patients (34.1%) and mean tumor size was significantly larger (3.0 ± 1.7 cm vs. 2.4 ± 1.1 cm; p = 0.097). Propensity score matching resulted in 30 matched pairs. After matching, 5-year overall survival did not significantly differ between the rescue and up-front hepatectomy groups. Multivariate analysis in the rescue hepatectomy group showed that serum α-fetoprotein concentration > 100 ng/mL was the only independent predictor of overall and disease-free survival. Conclusions Rescue hepatectomy appears to be feasible for selected patients with local recurrence of HCC after RFA or sTACE.