title: Surgical resection for recurrent hepatocellular carcinoma: prognosis and analysis of risk factors.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is common in Asian countries, and tumor recurrence is the most common cause of treatment failure after curative resection. Repeated hepatectomy is performed only for selected patients because most patients with HCC also have liver cirrhosis and poor liver function reserve. The purposes of this study were to clarify the outcome of the patients after second hepatectomy for recurrent HCC and to evaluate the prognostic factors after second hepatectomy.
  
  
  METHODS
  We used retrospective cohort study to examine the disease-free survival, cumulative survival, and possible prognostic factors for recurrence and death in 59 patients who underwent surgical resection for recurrent HCC at the National Taiwan University Hospital from August 1986 to December 1993. Another 64 patients with unresectable recurrent HCC were used as a historical control group. The survival curves between those patients with resectable HCC and those with unresectable HCC were compared.
  
  
  RESULTS
  After resection for recurrent HCC, gender and multiplicity (n > 3) of tumor affect recurrence rate (p = 0.046 and 0.021, respectively), whereas gender, age, and tumor invasiveness affect survival rate significantly (p = 0.024, 0.021, and 0.046, respectively). The survival rate of patients with resectable HCC was significantly better than that of those with unresectable HCC.
  
  
  CONCLUSIONS
  For recurrent HCC surgical resection is an effective mode of treatment in selected patients. Whether surgery is better than other modes of treatment in the treatment of resectable recurrent HCC demands further investigation.
authors.affiliation: Department of Surgery, College of Medicine, National Taiwan University, Taipei.
authors.forename: R H
authors.initials: RH
authors.lastname: Hu
authors.forename: P H
authors.initials: PH
authors.lastname: Lee
authors.forename: S C
authors.initials: SC
authors.lastname: Yu
authors.forename: H C
authors.initials: HC
authors.lastname: Dai
authors.forename: J C
authors.initials: JC
authors.lastname: Sheu
authors.forename: M Y
authors.initials: MY
authors.lastname: Lai
authors.forename: H C
authors.initials: HC
authors.lastname: Hsu
authors.forename: D S
authors.initials: DS
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate