Liver resection in patients with a history of local ablation for hepatocellular carcinoma has the risk of poor survival and serosal invasion

Abstract

Aim

The aim was to evaluate the impact of previous local ablation (LA) on long-term prognoses and tumor histopathological findings following hepatectomy for hepatocellular carcinoma (HCC).

Methods

This retrospective study used data from patients who underwent initial hepatectomy for HCC at Ehime University Hospital between October 2003 and July 2021. Using data from a total of 234 patients, after excluding patients with distant metastasis or macroscopic residual tumors and patients with mixed HCC, a group of 39 patients who underwent post-ablation liver resection (PALR) was compared with a group of 195 non-PALR patients with respect to patient characteristics, perioperative data, pathological findings, and outcomes.

Results

Number of tumors was significantly greater and diameter of tumor was smaller in PALR group than those of non-PALR group. Both overall survival (OS) and recurrence-free survival (RFS) were significantly poor in PALR group than those of non-PALR (5-year OS 54.1% vs. 66.9%, p = 0.024; 5-year RFS 24.7% vs. 37.0%, p = 0.019). However, PALR was not selected as independent prognosticator in multivariate analyses. In PALR group, tumor size ≥3 cm was sole independent prognosticator in multivariate analyses. Multivariate analysis showed that PALR [odds ratio (OR), 8.989; 95% confidence interval (CI), 2.807–28.787], alpha-fetoprotein level >40 ng/mL (OR, 2.923; 95% CI, 1.063–8.035), and des-γ-carboxyprothrombin level >170 mAU/mL (OR, 5.164; 95% CI, 1.622–16.438) were independent predictors of pathological serosal invasion.

Conclusions

Hepatectomy for patients with history of LA for HCC had a risk of serosal invasion and poor survival.