ORIGINAL ARTICLE   

Minerva Chirurgica 2018 June;73(3):255-60

DOI: 10.23736/S0026-4733.18.07643-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Post-surgical recurrence of hepatocellular carcinoma 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 Unit of Radiology, Department of Surgical Science, University of Turin, Turin, Italy; ² Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA; ³ Unit of Radiology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; ⁴ Liver Transplantation Center, Città della Salute e della Scienza University Hospital, Turin, Italy

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of percutaneous ablation for hepatocellular carcinoma (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 (49-82 y, 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 - Carcinoma, hepatocellular - Hepatectomy