title: Second hepatic resection for recurrent hepatocellular cancer: a Western experience.
abstract: OBJECTIVE
  Recurrence of hepatocellular cancer after resection is a significant problem. The optimal treatment of patients with intrahepatic recurrence after resection and well-preserved liver function is not clear. We analyzed the outcomes of patients undergoing a second hepatic resection for recurrent hepatocellular cancer at a single Western center.
  
  
  METHODS
  The records of all patients undergoing primary hepatic resection for hepatocellular cancer between January 1994 and January 2009 were reviewed. Patients with a single intrahepatic recurrence, Child's A liver function, and platelet count>100,000/μl underwent a second hepatic resection. Clinical data was recorded and analyzed.
  
  
  RESULTS
  Of the 487 patients undergoing primary resection, 221 developed recurrence, and 35 underwent a second hepatic resection. There were no perioperative mortalities. There were 10 deaths during the study period; 5-year overall survival was 67% from second resection. Time to recurrence from primary resection<1 year and gross vascular invasion at second resection were predictors of survival and recurrence. Patients with recurrence>1 year from primary resection and without gross vascular invasion had a 5-year survival of 81%. There were 17 recurrences with a 3-year recurrence rate of 55%.
  
  
  CONCLUSIONS
  Second hepatic resection for recurrent hepatocellular cancer is applicable in about 15% of patient with recurrence. The procedure is safe and can achieve excellent results in well-selected patients. Recurrence continues to be a significant problem.
authors.affiliation: Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY, USA. sasan.roayaie@mountsinai.org
authors.forename: Sasan
authors.initials: S
authors.lastname: Roayaie
authors.forename: Domenico
authors.initials: D
authors.lastname: Bassi
authors.forename: Paola
authors.initials: P
authors.lastname: Tarchi
authors.forename: Daniel
authors.initials: D
authors.lastname: Labow
authors.forename: Myron
authors.initials: M
authors.lastname: Schwartz
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome