title: Second hepatic resection for recurrent hepatocellular carcinoma in patients with chronic hepatitis C.
abstract: 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.
authors.affiliation: 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
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uenishi
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ohba
authors.forename: Masao
authors.initials: M
authors.lastname: Ogawa
authors.forename: Seikan
authors.initials: S
authors.lastname: Hai
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kodai
authors.forename: Hiroji
authors.initials: H
authors.lastname: Shinkawa
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D007372:Interferons