International Session(Symposium)1(JSH・JSGE・JSGCS)
Fri. November 3rd   14:30 - 17:00   Room 9: Portopia Hotel Main Building Kairaku 3
Management of HCC-recurrence after liver transplantation: Lessons from aggressive and tenacious surgical approach
Yuzo Umeda1, Tomokazu Fuji1, Toshiyoshi Fujiwara1
1Department of Gastroenterological Surgery, Okayama University
Introduction: HCC recurrence (HCC-rec) after liver transplantation (LT) could lead to dismal prognosis due to rapid tumor progression.
Aim and Methods: To analyze clinical features of HCC-rec and efficacy of surgical management, 87 living donor LT recipients with HCC between 1996 and 2021 were retrospectively analyzed.
Results: Ten patients showed HCC-rec (11.5%). Median follow-up period was 111 months and recurrence-free survival were 3.5% at 1 year, 9.6% at 2 years, and 12.4% at 5years after LT, respectively. These recurrent cases consisted of 6 cases of over-Milan criteria and 4 cases of within-Milan criteria which had mixed component of cholangiocarcinoma and /or micro-vascular invasion. HCC recurred at liver graft (n=2, 20%) and extra-hepatic sites (n=8, 80%) including bone, adrenal grand, lung, and IVC tumor thrombus. These HCC-rec were treated by surgical resection (n=5) and non-surgical therapy (n=4). Surgery groups showed single or oligo-recurrence, while non-surgery group showed multifocal recurrence. Surgery group comprised graft liver resection, lung or adrenal metastatectomy, and IVC resection. Subsequently, they were repeated multi-sites resection and multimodal therapies. The overall survival rates at 1/5 years after recurrence in surgery and non-surgery groups were 100/40% and 20/0%, respectively (p=0.0017). Consequently, a couple of HCC-rec cases conquered the progression of disease and led to long HCC-free survival.
Conclusion: Aggressive and tenacious surgical approach to HCC-rec after LT could have survival benefit as the hallmark treatment.
Index Term 1: HCC
Index Term 2: Liver transplantaion
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