Living donor liver transplantation should be cautiously considered as initial treatment in recurrent hepatocellular carcinoma within the Milan criteria after curative liver resection

BACKGROUND: Insufficient data are available about patient survival following different treatments for recurrent hepatocellular carcinoma (HCC) after primary hepatectomy. We retrospectively investigated the effectiveness of various treatment methods. METHODS: From 2005 to 2011, 515 hepatectomy patients who developed recurrence within the Milan criteria (MC) were grouped by treatment modality into living donor liver transplantation (LDLT), hepatic re-resection (RR), radiofrequency ablation (RFA), transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), and combination of TACE and RFA (TACE-RFA) group. RESULTS: Disease-free survival and patient survival after first HCC recurrence were compared according to treatment strategies. TACE (n=230, 44.7%), RFA (n=171, 33.2%), PEI (n=35, 6.8%), RR (n=45, 8.7%), salvage LDLT (n=21, 4.1%), and TACE-RFA (n=13, 2.5%) were all used as the first treatment in recurrent HCC within the MC. The disease-free survival curve from 1(st) HCC recurrence in the PEI group was lower than in the other groups (P=0.004). The RR, salvage LDLT, and TACE-RFA groups showed good long-term prognosis. The patient survival rate at 3 years after 1(st) HCC recurrence was 45.2% in TACE, 51.7% in RFA, 39.8% in PEI, 38.2% in RR, 81.4% in salvage LDLT, and 80.8% in the TACE-RFA group. Thus, the patient survival curve in the salvage LDLT and TACE-RFA groups was higher than in the other groups (P<0.001). CONCLUSIONS: Long-term outcomes for patients with recurrent HCC within the MC do not differ with the first treatment strategies, except for PEI. Salvage LDLT does not prevent HCC recurrence, but it increases patient survival compared with the other treatment strategies.