title: Is hepatic resection for recurrent or persistent hepatocellular carcinoma justified?
abstract: OBJECTIVE
  The safety and effectiveness of hepatic resection for recurrent or refractory hepatocellular is not established, particularly in cases treated by non-surgical treatment.
  
  
  METHODS
  Surgical outcomes of 38 patients who underwent curative hepatic resection for recurrent or refractory disease after previous treatment were evaluated. Univariate and multivariate analyses were performed to identify prognostic predictors.
  
  
  RESULTS
  There were no postoperative deaths, morbidity occurred in 9 patients (prolonged ascites retention, 5; biliary fistula, 3; intraabdominal abscess, 1), and all of them were treated conservatively. Recurrence-free and overall 1, 3 and 5-year-survival rate was 54, 28 and 24%, and 78, 60 and 55%, respectively. Multivariate analysis revealed hepatitis B or C virus infection (HR=12.8; 95% CI=2.3-245.1), tumor size >5 cm (HR=5.9; 95% CI=5.9-25.6), and vasculo- biliary invasion (HR=5.2; 95% CI=1.4-21.0) were independent predictors of poor overall survival. Type of previous treatment did not influence prognosis.
  
  
  CONCLUSIONS
  Hepatic resection for recurrent or refractory hepatocellular carcinoma is safe and achieves long survival in selected patients.
authors: Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: Yoji
authors: Y
authors: Kishi
authors: Akio
authors: A
authors: Saiura
authors: Junji
authors: J
authors: Yamamoto
authors: Rintaro
authors: R
authors: Koga
authors: Makoto
authors: M
authors: Seki
authors: Ryo
authors: R
authors: Morimura
authors: Ryuji
authors: R
authors: Yoshioka
authors: Norihiro
authors: N
authors: Kokudo
authors: Toshiharu
authors: T
authors: Yamaguch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden