Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.258
Peer-review started: September 26, 2022
First decision: November 15, 2022
Revised: November 28, 2022
Accepted: January 16, 2023
Article in press: January 16, 2023
Published online: February 27, 2023
Processing time: 154 Days and 6.9 Hours
Recurrent hepatocellular carcinoma (rHCC) is a common outcome after curative treatment. Retreatment for rHCC is controversial, and no guidelines are currently available.
Acceptable decision making for treatment of rHCC patients is a priority.
Our objectives were to conduct a network meta-analysis (NMA) to compare curative treatments including repeated hepatectomy (RH), radiofrequency ablation, transarterial chemoembolization (TACE), and liver transplantation (LT) for patients with rHCC after primary hepatectomy.
There were 30 articles involving patients with rHCC after primary liver resection from 2011 to 2021 that were retrieved for this NMA.
The best-pooled outcomes of four retreatment methods were analyzed by multiple testing methods. In general, the LT subgroup had superior disease-free survival (DFS) (P < 0.001), whereas the RH subgroup had superior overall survival (OS) without significant differences compared to other treatments.
RH and LT had better DFS and OS for rHCC than radiofrequency ablation and TACE. However, treatment strategies should be determined by the recurrent tumor characteristics, the patient’s general health status, and the care program of each institution.
Retreatment with RH, LT, radiofrequency ablation, or TACE are determined by factors such as liver function, tumor burden, metastasis, vascular invasion, and others. A multiparametric evaluation should be in place for personalized treatment of patients with rHCC and re-evaluated in the future.