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Pasini et al. Hepatoma Res 2020;6:26 Hepatoma Research
DOI: 10.20517/2394-5079.2019.47

Review Open Access

Treatment options for recurrence of hepatocellular
carcinoma after surgical resection: review of

the literature and current recommendations for
management

Francesco Pasini , Matteo Serenari , Alessandro Cucchetti , Giorgio Ercolani 1,2
1,2
1
1
1 Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy.
2 Department of Surgery, "Morgagni - Pierantoni" Hospital, Forlì 47121, Italy.
Correspondence to: Giorgio Ercolani, Department of Medical and Surgical Sciences - DIMEC, University of Bologna; Via
Massarenti 9, Bologna 40138, Italy. E-mail: giorgio.ercolani2@unibo.it
How to cite this article: Pasini F, Serenari M, Cucchetti A, Ercolani G. Treatment options for recurrence of hepatocellular
carcinoma after surgical resection: review of the literature and current recommendations for management. Hepatoma Res
2020;6:26. http://dx.doi.org/10.20517/2394-5079.2019.47
Received: 21 Dec 2019 First Decision: 9 Mar 2020 Revised: 23 Mar 2020 Accepted: 2 Apr 2020 Published: 16 May 2020

Science Editor: Stefano Brillanti Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu
Received: First Decision: Revised: Accepted: Published:

Science Editor: Copy Editor: Production Editor: Jing Yu
Abstract
The recurrence rate after primary resection for hepatocellular carcinoma (HCC) has been reported to be up to
80%. There is no consensus or guideline about the best treatment option for such recurrent HCC (rHCC). It is
therefore of paramount importance to select patients for suitable treatment due to the high risk of associated
morbidity and mortality. In this paper, we review the literature on treatment for rHCC and propose a strategy
based on the best evidence available. Even in rHCC, it is still possible to achieve cure and good survival rates
through careful patient selection. Repeat hepatectomy is recognized as a feasible and safe procedure even in
cirrhotic patients and should be considered as the best option with curative intent when the patient is fit enough.
Greater adoption of minimally-invasive liver surgery could have the potential to increase the number of candidate
patients with rHCC for repeat resection in the next few years. Liver transplantation offers longer disease-free
survival compared to repeat resection, curing the underlying cirrhosis, but is not widely available due to organ
shortage. When surgery is not feasible, locoregional treatments such as radiofrequency ablation and transarterial
chemoembolization have an important role for patients who cannot tolerate repeat hepatectomy and are not
suitable for transplantation. For advanced cases, systemic therapy could be considered.

Keywords: Recurrence, hepatocellular carcinoma, hepatic resection, second resection

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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