title: Recurrent hepatocellular carcinoma and poorer overall survival in patients undergoing left-sided compared with right-sided partial hepatectomy.
abstract: OBJECTIVE
  We aimed to determine the incidence and predictors of recurrent hepatocellular carcinoma (HCC) after partial hepatectomy.
  
  
  BACKGROUND
  Liver transplantation is the preferred treatment for selected patients with HCC, but access to donor organs is limited. Partial hepatectomy is another accepted treatment option; however, postoperative recurrence is frequently observed.
  
  
  METHODS
  This is a retrospective cohort study of 107 consecutive patients who underwent partial hepatectomy for HCC between January 1993 and February 2011 at a US University Medical Center. Study endpoints were recurrent HCC, death, loss to follow-up, or last visit without HCC.
  
  
  RESULTS
  The study cohort was 78% male with a median age of 61 years and 59% Asians. A total of 50 patients developed recurrent HCC (46.7%) after a median follow-up of 12 (1 to 69) months postresection. Recurrent HCC was significantly higher in patients with left-sided resection (41% at year 1, 54% at year 2, 62% at year 3, 81% at year 4, and 90% at year 5) compared with right-sided resection (18% at year 1, 34% at year 2, 36% at year 3, 44% at year 4, and 72% at year 5). In multivariate Cox proportional hazards model also inclusive of anatomic resection and TNM stage 3/4, left-sided resection was significantly associated with increased HCC recurrence (hazard ratio, 2.13; P=0.02; 95% confidence interval, 1.08-4.2) compared with right-sided resection.
  
  
  CONCLUSIONS
  HCC recurrence rate is higher among those undergoing left-sided resection: 54% at year 2 and 81% at year 4. Liver transplantation should be considered in patients who are at high risk for recurrence.
authors.affiliation: *Division of GI and Hepatology †Department of Surgery, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Antonia
authors.initials: A
authors.lastname: Valenzuela
authors.forename: Nghiem B
authors.initials: NB
authors.lastname: Ha
authors.forename: Amy
authors.initials: A
authors.lastname: Gallo
authors.forename: Clark
authors.initials: C
authors.lastname: Bonham
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
authors.forename: Marc
authors.initials: M
authors.lastname: Melcher
authors.forename: Lily H
authors.initials: LH
authors.lastname: Kim
authors.forename: Carlos
authors.initials: C
authors.lastname: Esquivel
authors.forename: Waldo
authors.initials: W
authors.lastname: Concepcion
authors.forename: Walid S
authors.initials: WS
authors.lastname: Ayoub
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lutchman
authors.forename: Tami
authors.initials: T
authors.lastname: Daugherty
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome