title: Recurrence patterns after hepatectomy of hepatocellular carcinoma: implication of Milan criteria utilization.
abstract: BACKGROUND
  Bridge hepatectomy followed by salvage liver transplantation has been proposed for patients with hepatocellular carcinoma (HCC) and preserved liver function.
  
  
  METHODS
  Data were prospectively collected for 501 consecutive patients who underwent curative primary hepatectomy for HCC between 1990 and 2006. Patient survival, disease-free survival (DFS), recurrence patterns, and risk factors were analyzed in patients classified according to the Milan criteria.
  
  
  RESULTS
  Patients were divided into two groups on the basis of whether their disease was within the Milan criteria (group 1, n = 321) or not (group 2, n = 180). Group 1 patient survival and DFS rates were 73.6% and 40.6% at 5 years. Recurrence was observed in 160 group 1 patients (49.8%); in 42 (26.3%) of these 160 patients, the recurrence exceeded the Milan criteria. No recurrence was noted in 145 group 1 patients (45.2%). Group 2 patient survival and DFS rates were 52.2% and 23.2%, respectively, at 5 years. Recurrence was noted in 116 patients (64.4%); recurrence in 58 (50.0%) of these patients was within the Milan criteria. In group 2, no recurrence was noted in 55 patients (30.6%). In group 1, indocyanine green retention rate at 15 minutes of >15%, nonanatomical resection, and multiple tumors were statistically significant risk factors for survival; 10-year patient survival was 78.5% for patients with no risk factors and 64.9% for patients with a single risk factor.
  
  
  CONCLUSIONS
  The Milan criteria should be used to recommend hepatectomy for patients with HCC; however, it is important to consider the high recurrence rate after hepatectomy and the possible requirement of salvage transplantation.
authors.affiliation: Department of General Surgery, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan. t-kamiya@med.hokudai.ac.jp
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nakanishi
authors.forename: Hideki
authors.initials: H
authors.lastname: Yokoo
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kamachi
authors.forename: Munenori
authors.initials: M
authors.lastname: Tahara
authors.forename: Tomomi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shimamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Furukawa
authors.forename: Michiaki
authors.initials: M
authors.lastname: Matsushita
authors.forename: Satoru
authors.initials: S
authors.lastname: Todo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D012307:Risk Factors; D016019:Survival Analysis