title: Efficacy of repeat hepatic resection for recurrent hepatocellular carcinomas.
abstract: BACKGROUND
  This study evaluated the efficacy of repeat hepatic resection for recurrent hepatocellular carcinoma (HCC) and the clinicopathological factors influencing overall survival after resection.
  
  
  METHODS
  From 1992 to 2005, 231 patients underwent curative hepatic resection for HCC at Yokohama City University, Japan. Of these, 105 patients developed intrahepatic recurrence, and 24 repeat hepatectomies were performed for recurrent HCC. Survival data were analysed, and prognostic factors for repeat hepatic resection were determined.
  
  
  RESULTS
  The overall cumulative 1-, 3- and 5-year survival rates and the median survival time of the patients after initial hepatic resection (n= 231) did not differ from those of the patients after repeat hepatic resection (n= 24), with values of 91.3, 70.2 and 49.1%, and 57 months, versus 91.7, 73.1 and 50.9%, and 61.5 months, respectively (P= 0.875). The operative time and blood loss in patients who underwent repeat hepatic resection did not differ from those who underwent primary resection. Multivariate analysis identified portal invasion at the first hepatic resection and a disease-free interval of <or=1.5 years after primary hepatic resection as independent risk factors for survival after repeat hepatic resection. The 12 patients who did not show either of the two prognostic factors had 3- and 5-year survival rates of 91.7 and 68.8%, respectively, after repeat hepatic resection.
  
  
  CONCLUSIONS
  Our findings suggest repeat hepatic resection as the treatment of choice for recurrent HCC patients without portal invasion at the first resection whose recurrence develops after a disease-free interval of >1.5 years since the previous surgery.
authors.affiliation: Yokohama City University Medical Center, Gastroenterological Center, Yokohama City, Japan. yasuhiko@urahp.yokohama-cu.ac.jp
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Michio
authors.initials: M
authors.lastname: Ueda
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome