title: Sequential multidisciplinary treatment of hepatocellular carcinoma: the role of surgery as rescue therapy for failure of percutaneous ablation therapies.
abstract: OBJECTIVE
  The recurrence of hepatocellular carcinoma (HCC) after percutaneous ablation is poorly evaluated.
  
  
  METHODS
  Thirty-six cases of recurrence after percutaneous ablation (PA) (Group 1) are compared to those after surgery, treated with re-resection (26 patients, Group 2) and PA (31 patients, Group 3).
  
  
  RESULTS
  Recurrence was usually local after PA and distant after resection. Compared to Groups 2 and 3, local recurrences after PA were larger (4.2 vs. 2.3 cm) and more often invasive (43% vs. 10%). No different clinical/pathological aspects were noted in distant recurrences among the groups. After treatment the survival rate (1, 2, 3 and 5 years) was no different between the groups; in an intention-to-treat analysis of survival for local recurrences, survival was significantly lower in Group 1 (78%, 78%, 67% and 28%) than in Groups 2 and 3 (100%, 88%, 75% and 45%) (P < 0.05).
  
  
  CONCLUSIONS
  PA and surgery can be sequentially employed for HCC. The type of primary treatment does not influence the features of distant liver recurrence, while local recurrence after PA often requires more extensive liver resection.
authors.affiliation: Department of Medical and Surgical Sciences, Surgical Clinic, Brescia University, Brescia, Italy.
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Baiocchi
authors.forename: Arianna
authors.initials: A
authors.lastname: Coniglio
authors.forename: Luigi
authors.initials: L
authors.lastname: Grazioli
authors.forename: Eleonora
authors.initials: E
authors.lastname: Frassi
authors.forename: Federico
authors.initials: F
authors.lastname: Gheza
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Giulini
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006498:Hepatectomy; D006801:Humans; D015552:Injections, Intralesional; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D017211:Treatment Failure
chemical_list: D000431:Ethanol