Second hepatic resection for recurrent hepatocellular carcinoma in patients with chronic hepatitis C.
BACKGROUND
Although a second hepatic resection (SHR) for recurrent hepatocellular carcinoma (HCC) is widely accepted, the indications for SHR have not been established. The risk factors for HCC recurrence after SHR were evaluated to investigate the indications for SHR.


METHODS
Subjects included 51 patients who underwent a second hepatic resection for recurrence of HCV-related HCC. Sixteen patients received interferon therapy before or after the first operation. Six patients attained a sustained viral response (SVR) that was defined as return of the alanine aminotransferase (ALT) activity to within the reference range and no detectable serum HCV RNA for at least 1 year after interferon therapy. A biochemical response (BR), defined as a normalized ALT activity for at least 1 year after interferon therapy with or without the transient disappearance of serum HCV RNA, was attained in three patients. The other seven patients were defined as the nonresponse (NR) group.


RESULTS
By univariate analysis, NR and lack of interferon therapy, high indocyanine green retention rate at 15 min (ICGR15), high aspartate aminotransferase activity, high ALT activity, large tumor, and multiple tumors were risk factors for HCC recurrence after SHR. By multivariate analysis, NR and lack of interferon therapy, high ICGR15, large tumor, and multiple tumors were independent risk factors.


CONCLUSIONS
Patients in whom active hepatitis has been controlled by interferon therapy are the best candidates for SHR. Interferon therapy should be recommended in patients undergoing resection of an HCV-related HCC because SHR can prolong life in SVR and BR patients.
Kubo
Shoji
S
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan. m7696493@msic.med.osaka-cu.ac.jp
Takemura
Shigekazu
S
Uenishi
Takahiro
T
Yamamoto
Takatsugu
T
Ohba
Kazuki
K
Ogawa
Masao
M
Hai
Seikan
S
Ichikawa
Tsuyoshi
T
Kodai
Shintaro
S
Shinkawa
Hiroji
H
Tanaka
Hiromu
H
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007372:Interferons / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D007372:Interferons