Chemoembolization and percutaneous ethanol injection for intrahepatic recurrence of hepatocellular carcinoma after hepatic resection.

Background/aims: Management of 36 patients who developed intrahepatic recurrence (IHR) after curative hepatic resection for hepatocellular carcinoma (HCC) was studied.

Materials And Methods: IHRs were classified into type I with a solitary lesion (n = 16), type II with 2-4 lesions (n = 11), and type III with > or = 5 lesions (n = 11).

Results: Periodic angiography and Lipiodol CT first detected IHRs in six patients. Most IHRs in type I and II were smaller than 20 mm. Thirty-three patients underwent regional treatments including transarterial infusion of Lipiodol containing anticancer drugs (TAIL) (n = 19), combined TAIL and percutaneous ethanol injection PEI (n = 12), surgery (n = 3), and PEI (n = 1). Post-recurrence 5-yr survival rate of type I (51%) was higher than that of type II (0%) or III (0%) (p < 0.01). Of the 27 patients with type I and II recurrences, seven became tumor-free for 11-67 months after regional treatments including TAIL + PEI (n = 5), TAIL (n = 1), and surgery (n = 1); 13 developed multiple IHRs.

Conclusions: Postoperative close follow-up with qualified imaging and vigorous treatments prolong the survival of the patients with HCC who developed IHRs. Type I or type II IHR can be curable with the combination of TAIL and PEI or repeated surgery.