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A Journal on Surgery

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Minerva Chirurgica 2018 Feb 21

DOI: 10.23736/S0026-4733.18.07643-5


language: English

Post-surgical recurrence of HCC along resection margin treated by percutaneous US-guided ablation

Marco CALANDRI 1 , Carlo GAZZERA 1, Steven YEVICH 2, Katia LAPENNA 1, Maria MARENCO 1, Andrea VELTRI 3, Gianluca PARALUPPI 4, Paolo FONIO 1

1 Radiology Unit, Department of Surgical Science, University of Turin, Turin, Italy; 2 Interventional Radiology Department, MD Anderson Cancer Center, Houston, TX, USA; 3 Reparto di Radiodiagnostica, Dipartimento di Oncologia, Ospedale San Luigi Gonzaga, Orbassano, Turin, Italy; 4 Liver Transplantation Center, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy


BACKGROUND: To evaluate the safety and efficacy of percutaneous ablation for HCC hepatic recurrence along surgical resection margins to achieve complete cure or bridge for additional treatment. No current recommendations exist for these lesions.
METHODS: Retrospective review of post-surgical recurrent HCC located along surgical margins treated by percutaneous ultrasound-guided ablation from 2006-2014. Ablation was performed by radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI), selected for recurrence in proximity to extrahepatic organs.
RESULTS: In total, nine patients (49-82yo, mean 73.8±8.3) were treated for 13 recurrent HCC nodules (9-35 mm, mean 21.5±8.1) located along resection margins by RFA (11 nodules) and PEI (2 nodules). Mean time between surgery and percutaneous ablation was 64 months (range 10-149). At a mean follow-up of 17 months (± 9), complete ablation was achieved in 9 nodules (69.2%, 8 after RF, 1 after PEI) and partial ablation was achieved in 4 nodules (3 after RFA, 1 after PEI). Complications were limited to minor abdominal pain in 2 patients requiring medical therapy (15.3%). Of the 4 partially ablated nodules, subsequent therapy achieved complete response in 3 nodules (1 patient with TACE, 1 patient with stereotactic radiotherapy, and one with liver transplantation), while the last nodule progressed despite subsequent TACE.
CONCLUSIONS: HCC recurrence along the surgical margin can be safely and effectively treated by percutaneous therapy, despite the misconception of the surgical margin as a hostile location. Percutaneous treatment may bridge the patient for additional therapy.

KEY WORDS: Radiology, interventional - Hepatocellular carcinoma - Hepatectomy

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Publication History

Article first published online: February 21, 2018
Manuscript accepted: February 9, 2018
Manuscript received: January 24, 2018

Cite this article as

Calandri M, Gazzera C, Yevich S, Lapenna K, Marenco M, Veltri A, et al. Post-surgical recurrence of HCC along resection margin treated by percutaneous US-guided ablation. Minerva Chir 2018 Feb 21. DOI: 10.23736/S0026-4733.18.07643-5

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