title: Clinical efficacy and predictors of outcomes of repeat hepatectomy for recurrent hepatocellular carcinoma - a systematic review.
abstract: BACKGROUND
  Primary hepatectomy is an accepted treatment for primary hepatocellular carcinoma (HCC) with good long-term survival, but high rates of recurrence. This review aims to evaluate the safety and efficacy of repeat hepatectomy for recurrent HCC after initial hepatectomy.
  
  
  METHODS
  Electronic searches identified 22 eligible studies comprising of 1125 patients for systematic review. Studies with >10 patients, adopting repeat hepatectomy treatment for recurrent HCC initially treated with hepatectomy were selected for inclusion. A predetermined set of data comprising demographic details, morbidity and mortality indices and survival outcomes were collected for every study and tabulated.
  
  
  RESULTS
  Majority of patients selected for repeat hepatectomy had Child-Pugh A (median 94%, range 40-100). Intrahepatic recurrence occurred at a median of 22.4 (range 12-48) months in this patient cohort with single nodule recurrences comprising of 70% of cases. The median mortality rate was 0% (range 0-6%). Prolonged ascites was observed in a median of 4% (range 0-32%), bleeding in 1% (range 0-9%), bile leak in 1% (range 0-6%) and liver failure in 1% (range 0-2%). The median disease-free survival was 15 (range 7-32) months and median overall survival was 52 (range 22-66) months. Median 3-year and 5-year survival was 69% (range 41-88%) and 52% (range 22-83%) respectively. Recurrences occurring 12-18 months after initial hepatectomy was consistently associated with improved survival.
  
  
  CONCLUSIONS
  Synthesized data from observational studies of repeat hepatectomy suggests that this treatment approach for recurrent HCC is safe and achieves long-term survival. Standardization of criteria for repeat hepatectomy and a randomized trial are warranted.
authors.affiliation: UNSW Department of Surgery, St George Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Chan
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate