Surgical Strategies for Recurrent Hepatocellular Carcinoma after Resection: A Review of Current Evidence

SIMPLE SUMMARY: Among primary liver cancers, hepatocellular carcinoma (HCC) is the most common. Surgical resection and liver transplantation both represent potentially curative treatments not only in the case of the first occurrence, but also in those cases of disease recurrence if a proper selection of patients is performed ahead. Incidentally, the type and the time of relapse carry important weight on patient prognosis and overall survival. For these cases, proper management has still not been exactly defined. If precise indications for HCC first occurrence are quite clear, very few clear indications have been reported in those cases of relapse. The authors, after an extensive review of the published literature, aimed to summarize the modalities and the histopathological patterns of HCC recurrence, their prognostic value, and the main surgical strategies to deal with HCC relapse. At this point, either for redo hepatectomy or salvage liver transplantation, the pros and the cons have been detailed with the aim of characterizing the most suitable patients for receiving one or another. Some studies where such treatments were compared have been reported as well. ABSTRACT: Hepatocellular carcinoma (HCC) is the most common primary liver cancer, and both liver resection and liver transplantation are considered potentially curative options. However, high recurrence rates affect the prognosis depending both on the primary HCC pathology characteristics or on the type and time of the relapse. While great attention has been usually posted on treatment algorithms for the first HCC, treatment algorithms for recurrent HCC (rHCC) are lacking. In these cases, surgery still represents a curative option with both redo hepatectomy and/or salvage liver transplantation, which are considered valid treatments in selected patients. In the current era of personalised medicine with promises of new systemic-targeted immuno-chemotherapies, we wished to perform a narrative review of the literature on the role of surgical strategies for rHCC.