title: Risk factors of peritoneal recurrence and outcome of resected peritoneal recurrence after liver resection in hepatocellular carcinoma: review of 1222 cases of hepatectomy in a tertiary institution.
abstract: BACKGROUND
  Reports on the risk factors of peritoneal recurrence (PR) after liver resection for hepatocellular carcinoma are lacking. We examined the risk factors of PR after hepatectomy and the outcome of resected PR at our institution.
  
  
  METHODS
  We retrospectively reviewed the data from 1,222 patients who underwent hepatectomies for hepatocellular carcinoma in Samsung Medical Center from January 2006 to August 2010. We identified patients with PR and studied the risk factors and outcomes of resected PR.
  
  
  RESULTS
  The rate of PR was 3.0% (n=36). The mean±SD age of patients was 54.0±10.2 years. Among those with PR, 23 patients (63.9%) had unresectable disease and 13 patients (36.1%) had resectable disease. Multivariate analysis found that tumor size>50 mm, presence of microvascular invasion, bile duct invasion, and positive margins were significant risk factors of PR after liver resection. The median overall survival (OS) for resectable PR was 33.0 (28.0-61.6) months compared to 14.0 (6.8-21.2) months for unresectable PR (P=0.009). Cox regression analysis demonstrated that resected PR [hazard ratio (HR) 0.042, P = 0.001] and interval between hepatectomy and PR (>6 months) (HR 0.195, P=0.016) were positive prognostic factors for OS, while alfa-fetoprotein>200 ng/dl at detection of PR (HR 11.321, P=0.015) and serosal involvement of primary hepatocellular carcinoma (HR 25.616, P=0.007) were negative prognostic factors for OS.
  
  
  CONCLUSIONS
  We found that tumor size>50 mm, presence of microvascular invasion, bile duct invasion, and positive resection margins were significant risk factors of PR after liver resection. Selected patients with resected PR had significantly better OS.
authors.affiliation: Department of HPB Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore, Singapore.
authors.forename: Alfred Wei Chieh
authors.initials: AW
authors.lastname: Kow
authors.forename: Choon Hyuck David
authors.initials: CH
authors.lastname: Kwon
authors.forename: Sanghyun
authors.initials: S
authors.lastname: Song
authors.forename: Milljae
authors.initials: M
authors.lastname: Shin
authors.forename: Jong Man
authors.initials: JM
authors.lastname: Kim
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Joh
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate