title: Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma.
abstract: OBJECTIVE
  The aims of this study were to identify prognostic factors in patients who developed recurrent hepatocellular carcinoma (HCC) after repeat hepatectomy and to elucidate the role of multicentric occurrence in the second tumor after a first hepatectomy.
  
  
  BACKGROUND
  A repeat hepatectomy for recurrent HCC has been established as the most effective treatment modality, whenever it is possible. However, the prognostic factors for recurrent HCC after repeat hepatectomy have yet to be clarified.
  
  
  METHODS
  Forty-one patients who underwent a curative repeat hepatectomy were retrospectively studied. Patient survival and disease-free survival after recurrence were univariately and multivariately analyzed using 38 clinicopathologic variables. The histologic grade of HCC at repeat hepatectomy was also compared with that at first hepatectomy.
  
  
  RESULTS
  Patient survival after repeat hepatectomy did not differ substantially from that in 312 patients undergoing primary hepatectomy. However, the disease-free survival after repeat hepatectomy was significantly lower than that in patients with only a primary hepatectomy (p < 0.05). Multivariate analysis revealed only portal vein invasion in the first hepatectomy to be an independent and significantly poor prognostic factor. Regarding multicentric occurrence at repeat hepatectomy, only 6 of 40 patients (15%) whose specimens could be evaluated histologically were determined to be Edmondson and Steiner's Grade 1.
  
  
  CONCLUSIONS
  The only prognostic factor identified in patients with recurrent HCC after repeat hepatectomy was portal vein invasion in the first hepatectomy. Most second tumors after the first hepatectomy are considered to be caused by metastatic recurrence, not by multicentric occurrence.
authors.affiliation: Department of Surgery II, Faculty of Medicine, Kyushu University, Maidashi, Fukuoka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Shimada
authors.forename: K
authors.initials: K
authors.lastname: Takenaka
authors.forename: K
authors.initials: K
authors.lastname: Taguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: T
authors.initials: T
authors.lastname: Gion
authors.forename: K
authors.initials: K
authors.lastname: Kajiyama
authors.forename: T
authors.initials: T
authors.lastname: Maeda
authors.forename: K
authors.initials: K
authors.lastname: Shirabe
authors.forename: K
authors.initials: K
authors.lastname: Yanaga
authors.forename: K
authors.initials: K
authors.lastname: Sugimachi
mesh_terms: D000465:Algorithms; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D003663:Decision Trees; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors