**Author details**

*Liver Disease and Surgery*

for a persistent recurrence risk is maintained [107].

after major or limited primary hepatectomy [70, 108].

patients, despite repeated treatments [103, 104].

US should be performed every 6 months within the first 5 years after surgical treatment; a second level imaging study is requested at the first year and repeated after 12–18 months according to the underlying liver status [5]. Resected patients for HCC, who received direct-acting antiviral (DAA) therapy for HCV negativization, are commonly kept in a less intensive follow-up with US every 12–18 months,

Once detected, RHCC shall be carefully assessed in order to plan the best therapy. Re-resection is the treatment of choice if nodule is resectable and patient is eligible for surgery; so, disease-free time, performance status, future remnant liver volume and function, cirrhosis, portal hypertension and other aspects should be evaluated again before repeating operation. Only about 20% of patients with recurrent HCC receive surgical treatment [105]. Multiple resections could be performed

Both open and laparoscopic resections can be carried out, but laparotomy is generally preferred, since intra-abdominal adhesions limit laparoscopic approach [109]. Five-year survival rate higher than 70% can be achieved in well-selected

sion are positive prognostic factors after second resection [105, 108].

worsened liver function and falling within transplant criteria [70, 103].

be performed in fit patients with quality of life and survival benefits [27].

and NAFLD, because they are followed up more strictly.

tions allow important survival benefits at 3, 5 and 10 years.

HCC is a deadly malignancy either in cirrhotic and non-cirrhotic patients. A well-timed follow-up and detection of patients at risk are fundamental, since diagnosis at early stage allows more aggressive and effective treatments. HCC in non-cirrhotic liver will be more often diagnosed, particularly in the case of NASH

In recent years, indications to surgery have not changed substantially, while a lot has been introduced in terms of imaging, which is nowadays an essential support in preoperative planning, intraoperative guide and postoperative follow-up. Staged hepatectomy techniques have shown interesting results and will become part of clinical practice in the future, especially in treatment of non-cirrhotic patients. Surgery remains the most effective treatment against HCC, since complete resec-

Prognosis after repeated resections is linked to clinic-pathological characteristics of primary HCC and recurrence interval. Particularly a disease-free period longer than 1 year after primary resection, single primary HCC and negative portal inva-

Other possible locoregional therapies for recurrent illness are RFA, MWA and TACE. Liver transplantation could be taken into account in selected patients with

Incidence of extrahepatic metastases (EHM) after hepatectomy is low (range 5–20%) [108, 110]. High-serum alpha-fetoprotein levels, after liver resection or transplant, is suspicious for extrahepatic recurrence; thus serial cross-sectional total body imaging is mandatory to identify them, and palliative R0 resection may

**90**

**5. Conclusion**

Stefania Brozzetti1 \*, Simone Bini1 , Chiara D'Alterio1 , Chiara De Lucia1 , Leonardo Luca Chiarella1 , Katia Fazzi1 and Michele Di Martino2

1 Department of Surgery "Pietro Valdoni", Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy

2 Deparment of Radiological Sciences, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy

\*Address all correspondence to: stefania.brozzetti@uniroma1.it

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
