Ann Hepatobiliary Pancreat Surg.  2019 Nov;23(4):305-312. 10.14701/ahbps.2019.23.4.305.

Repeat liver resection versus salvage liver transplant for recurrent hepatocellular carcinoma: A propensity score-adjusted and -matched comparison analysis

Affiliations
  • 1Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. bsgkp@hotmail.com
  • 2Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
  • 3Duke-National University of Singapore (NUS) Medical School, Singapore.

Abstract

BACKGROUNDS/AIMS
Repeat liver resection (RLR) and salvage liver transplantation (SLT) are viable treatment options for recurrent hepatocellular carcinoma (HCC). With possibly superior survival outcomes than RLR, SLT is however, limited by liver graft availability and poses increased perioperative morbidity. In this study, we seek to compare the outcomes of RLR and SLT for patients with recurrent HCC.
METHODS
Between 1999 and 2018, 94 and 16 consecutive patients who underwent RLR and SLT respectively were identified. Further retrospective subgroup analysis was conducted, comparing 16 RLR with 16 SLT patients via propensity-score matching.
RESULTS
After propensity-score adjusted analyses, SLT demonstrated inferior short-term perioperative outcomes than RLR, with increased major morbidity (57.8% vs 5.4 %, p=0.0001), reoperations (39.1% vs 0, p<0.0001), renal insufficiency (30.1% vs 3%, p=0.0071), bleeding (19.8% vs 2.2%, p=0.0289), prolonged intensive care unit stay (median=4 vs 0 days, p<0.0001) and hospital stay (median=19.8 vs 7.1days, p<0.001). However, SLT showed significantly lower recurrence rate (15.4% versus 70.3%, p=0.0005) and 5-year cumulative incidence of recurrences (19.4% versus 68.4%, p=0.005). Propensity-matched subgroup analysis showed concordant findings.
CONCLUSIONS
While SLT offers potentially reduced risks of recurrence and trended towards improved long-term survival outcomes relative to RLR, it has poorer short-term perioperative outcomes. Patient selection is prudent amidst organ shortages to maximise allocated resources and optimise patient outcomes.

Keyword

Hepatocellular carcinoma; Salvage liver transplantation; Repeat liver resection; Tumour recurrence; Survival analysis; Propensity score

MeSH Terms

Carcinoma, Hepatocellular*
Hemorrhage
Humans
Incidence
Intensive Care Units
Length of Stay
Liver Transplantation
Liver*
Patient Selection
Propensity Score
Recurrence
Renal Insufficiency
Retrospective Studies
Shiga Toxin 1
Survival Analysis
Transplants
Shiga Toxin 1
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