title: Results of 404 hepatic resections including 80 repeat hepatectomies for hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate our treatment protocol applied to patients with hepatocellular carcinoma. The protocol consists of the selection criteria for hepatectomy, the use of techniques that minimize intraoperative blood loss, strict follow-up after surgery, and an aggressive surgical approach for intrahepatic recurrence.
  
  
  METHODS
  We conducted a retrospective cohort study that included 337 patients with hepatocellular carcinoma treated between 1990 and 2001. The type of resection was selected according to the serum bilirubin value and the indocyanine green retention rate at 15 minutes. Perioperative data and long-term outcome were examined.
  
  
  RESULTS
  We performed 324 initial hepatectomies with an in-hospital mortality rate close to zero. There was one operative death and one hospital death (0.3% each), and the 5-year survival rate for all patients was 53.2%. Eighty repeat liver resections, including 18 third and two fourth, were performed with no mortality, and the 5-year survival rate was 52.9% after the second hepatic resection. The resectability rate for second and third hepatectomies reached 29% and 33% of all patients with isolated liver recurrence, respectively.
  
  
  CONCLUSIONS
  Liver resection is a safe and effective treatment modality for hepatocellular carcinoma. Our results are likely attributable to the routine application of our treatment protocol.
authors.affiliation: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawasaki
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Shiro
authors.initials: S
authors.lastname: Miwa
authors.forename: Terumasa
authors.initials: T
authors.lastname: Noike
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takagi
authors.forename: Satoru
authors.initials: S
authors.lastname: Iijima
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyagawa
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D002985:Clinical Protocols; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome