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Repeat liver resection versus salvage liver transplant for recurrent hepatocellular carcinoma: A propensity score-adjusted and -matched comparison analysis
Ann Hepatobiliary Pancreat Surg 2019 Nov;23(4):305-12
Published online November 30, 2019;  https://doi.org/10.14701/ahbps.2019.23.4.305
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Yuxin Guo1, Ek-Khoon Tan1, Nicholas L. Syn1, Thinesh-Lee Krishnamoorthy2, Chee-Kiat Tan2, Reina Lim2, Ser-Yee Lee1, Chung-Yip Chan1, Peng-Chung Cheow1, Alexander Y. F. Chung1, Prema Raj Jeyaraj1, and Brian K. P. Goh1,3

Departments of 1Hepatopancreatobiliary and Transplant Surgery, and 2Gastroenterology and Hepatology, Singapore General Hospital, 3Duke-National University of Singapore (NUS) Medical School, Singapore
Received January 2, 2019; Revised June 25, 2019; Accepted July 4, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Backgrounds/Aims: Repeat liver resection (RLR) and salvage liver transplantation (SLT) are viable treatment options for recurrent hepatocellular carcinoma (HCC). With possibly superior survival outcomes than RLR, SLT is however, limited by liver graft availability and poses increased perioperative morbidity. In this study, we seek to compare the outcomes of RLR and SLT for patients with recurrent HCC.
Methods: Between 1999 and 2018, 94 and 16 consecutive patients who underwent RLR and SLT respectively were identified. Further retrospective subgroup analysis was conducted, comparing 16 RLR with 16 SLT patients via propensity-score matching.
Results: After propensity-score adjusted analyses, SLT demonstrated inferior short-term perioperative outcomes than RLR, with increased major morbidity (57.8% vs 5.4%, p=0.0001), reoperations (39.1% vs 0, p<0.0001), renal insufficiency (30.1% vs 3%, p=0.0071), bleeding (19.8% vs 2.2%, p=0.0289), prolonged intensive care unit stay (median=4 vs 0 days, p<0.0001) and hospital stay (median= 19.8 vs 7.1days, p<0.001). However, SLT showed significantly lower recurrence rate (15.4% versus 70.3%, p=0.0005) and 5-year cumulative incidence of recurrences (19.4% versus 68.4%, p=0.005). Propensity-matched subgroup analysis showed concordant findings.
Conclusions: While SLT offers potentially reduced risks of recurrence and trended towards improved long-term survival outcomes relative to RLR, it has poorer short-term perioperative outcomes. Patient selection is prudent amidst organ shortages to maximise allocated resources and optimise patient outcomes.
Keywords : Hepatocellular carcinoma; Salvage liver transplantation; Repeat liver resection; Tumour recurrence; Survival analysis; Propensity score