title: Re-resection for metachronous primary hepatocellular carcinoma: is it justified?
abstract: BACKGROUND
  In management of intrahepatic recurrence of hepatocellular carcinoma (HCC), controversy exists over the efficacy of re-resection for patients with preserved liver function. This study aimed to determine the long-term outcomes of re-resection in these patients.
  
  
  METHODS
  Prospectively collected data of 47 patients having re-resection (Group R) with curative intent for metachronous primary HCC between December 1989 and December 2007 were compared with those of 863 patients having primary resection (Group P) in the same period. There was no overlap of patient. All patients had gross tumour-free resection margin.
  
  
  RESULTS
  The two groups had comparable demographics. Group R had a median age of 58 years (range, 48-67 years), and had almost all patients belonging to Child-Pugh class A (46/47). Median blood loss was 0.66 L (range, 0.3-1.28 L) for Group P and 0.37 L (range, 0.13-0.92 L) for Group R. Both groups had median blood transfusion rate at 0. Median operative time was 365 min (range, 240-490 min) for Group P and 270 min (range, 193-360 min) for Group R. Group R had significantly fewer tumour nodules and the only one operative death. Median follow-up was 41 months for Group P and 37 months for Group R (P= 0.133). The two groups displayed no significant differences in disease-free survival and overall survival. Univariate analysis showed that re-resection was not a significant risk factor in overall survival.
  
  
  CONCLUSIONS
  Re-resection for metachronous primary HCC for patients with preserved liver function can achieve favourable survival outcome.
authors.affiliation: Department of Surgery, University of Hong Kong, Hong Kong, China. keithywong@gmail.com
authors.forename: Kenneth Siu Ho
authors.initials: KS
authors.lastname: Chok
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Ronnie Tung Ping
authors.initials: RT
authors.lastname: Poon
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome