Introduction: Resection of hepatocellular carcinoma (HCC) is associated with high rates of intrahepatic recurrence. However, it is unclear whether recurrence results from occult multifocal disease or de novo tumor formation due to a “field defect.” To test the hypothesis that intrahepatic recurrence after partial hepatectomy represents occult multifocality, we examined explant pathology reports from liver transplants (OLTs) performed for HCC.

Methods: We collected data on HCC patients treated surgically from 3,975 OLTs in the Organ Procurement and Transplantation (OPTN) national database, 299 liver transplants at a single transplant center, and 232 hepatectomies from a hepatobiliary center. At the high volume transplant center, each explanted liver was serially sectioned at 3- to 5 mm- intervals and examined for macroscopic HCC lesions.

Results: In the OPTN and high volume transplant center cohorts, 41% and 43% of patients had occult HCC lesions on explant pathology (Table 1). Among resection center patients, the 2-year recurrence rate was 46%, of which 74% had liver only recurrence. Among the single transplant center patients, 2-year recurrence after OLT was 8%.

Conclusion: The incidence of occult multifocality in transplant explants corresponded to the 46% early recurrence rate following partial hepatectomy. Although organ supply limits transplantation for HCC, these data suggest that noncurative resection may result from occult, intrahepatic multifocality rather than a “field defect” predisposing to de novo tumorigenesis.

CITATION INFORMATION: Aufhauser Jr D, Sadot E, Murken D, Eddinger K, Goldberg D, Furth E, Abt P, DeMatteo R, Levine M. Occult Multifocal Hepatocellular Carcinoma in Surgical Patients. Am J Transplant. 2016;16 (suppl 3).

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