title: Salvage treatment for local recurrence of hepatocellular carcinoma after local ablation therapy.
abstract: OBJECTIVE
  Local recurrence of hepatocellular carcinoma (HCC) after local ablation therapy (LAT) is a serious problem; however, the optimal treatment strategy remains unclear.
  
  
  METHODS
  A retrospective analysis was conducted of 50 patients with local recurrence of HCC after LAT that underwent either salvage hepatectomy (n = 23) or radiofrequency ablation (RFA; n = 27). Their background characteristics, intraoperative data, and postoperative short- and long-term outcome were analyzed.
  
  
  RESULTS
  The RFA group was found to be significantly associated with an impaired liver functional reserve, smaller number and size of tumors. The hepatectomy group showed a significantly longer operation time, greater intraoperative blood loss and more frequent red blood cell transfusion. In-hospital stay mortality and morbidity rate did not significantly differ. The disease-free and overall survival showed no significant difference between the groups. Although local recurrence after salvage treatment was found in zero (0%) for hepatectomy and in seven (25.9%) for RFA, that did not affect the overall survival. The tumor size at the prior LAT was identified as an independent prognostic factor for disease-free survival and serum albumin for overall survival.
  
  
  CONCLUSIONS
  Whereas salvage hepatectomy for local recurrent HCC is recommended for selected patients in terms of its good local control effect, salvage RFA is also acceptable because it is less invasive and also has a reasonable long-term outcome.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Imai
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Kosuke
authors.initials: K
authors.lastname: Mima
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Okabe
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Hayashi
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Nitta
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Ishiko
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
keywords: hepatocellular carcinoma; local ablation therapy; local recurrence; radiofrequency ablation; salvage treatment