Abstract: Objective To evaluate the clinical efficacy of repeat hepatectomy and local ablation in patients with recurrent hepatocellular carcinoma (HCC). Methods A retrospective analysis was conducted on 64 patients who presented with intrahepatic recurrence of HCC post-surgery between January 2020 and November 2023. Based on the post-relapse surgical procedure adopted, they were divided into two groups: 26 patients underwent a repeat hepatectomy through open surgery, and 38 patients underwent local ablation using ultrasound-guided tumor ablation. Surgical parameters, postoperative recurrence, and survival outcomes were recorded. Results The Patients in local ablation group showed significantly lower operation time, less intraoperative blood loss, and shorter hospital stay, with values of (52.7±16.6) min, (3.9±1.5) mL, and (4.3±1.1) days, respectively, compared to those of (146.3±23.5) min, (205.1±12.7) mL, and (12.2±3.6) days in the repeat hepatectomy group, P<0.05. The overall survival rates (OS) for the repeat hepatectomy and local ablation groups, at 1, 3, and 5 years were 88.4%, 69.2%, 61.5% and 86.8%, 73.6%, 57.8%, respectively. There was no significant difference in overall survival (OS) between these two groups (P=0.16). The recurrence-free survival rates (RFS) at 1, 2, and 3 years post-operation were 76.9%, 65.3%, 57.6% for the repeat hepatectomy group, and 73.6%, 50%, 23.6% for the local ablation group, which had a statistically significant difference (P=0.042).Using COX regression analysis, it was found that the significant risk factors affecting OS were older age at recurrence (RR=1.6, 95%CI=1.1-2.3, P<0.05), AFP level higher than 400 ng/mL (RR=2.8, 95%CI=1.2-4.2, P<0.05), and tumors adjacent to major vessels at the time of recurrence (RR=2.9, 95%CI=1.1-5.7, P<0.05). A single recurrent lesion was identified as a protective factor for OS with an RR value of 0.4 (95%CI=0.2-0.7, P<0.05). For RFS, age (RR=1.8, 95%CI=1.1-3.1, P<0.05) and tumors adjacent to major vessels (RR=2.6, 95%CI=1.2-4.4, P<0.05) were risk factors, while a single recurrent lesion served as a protective factor with an RR value of 0.5 (95%CI=0.2-0.8, P<0.05). Conclusion For HCC recurrence that meets the Milan criteria, both repeat hepatectomy and local ablation treatments are feasible and safe.

Key words: Hepatocellular Carcinoma, HCC Recurrence, Repeat Hepatectomy, Local Ablation (LA), Overall Survival Rate, recurrence-free survival Rate, Risk Factors