title: Role of hepatectomy for recurrent or initially unresectable hepatocellular carcinoma.
abstract: As a result of donor shortage and high postoperative morbidity and mortality after liver transplantation, hepatectomy is the most widely applicable and reliable option for curative treatment of hepatocellular carcinoma (HCC). Because intrahepatic tumor recurrence is frequent after loco-regional therapy, repeated treatments are advocated provided background liver function is maintained. Among treatments including local ablation and transarterial chemoembolization, hepatectomy provides the best long-term outcomes, but studies comparing hepatectomy with other nonsurgical treatments require careful review for selection bias. In patients with initially unresectable HCC, transarterial chemo-or radio-embolization, and/or systemic chemotherapy can down-stage the tumor and conversion to resectable HCC is achieved in approximately 20% of patients. However, complete response is rare, and salvage hepatectomy is essential to help prolong patients' survival. To counter the short recurrence-free survival, excellent overall survival is obtained by combining and repeating different treatments. It is important to recognize hepatectomy as a complement, rather than a contraindication, to other nonsurgical treatments in a multidisciplinary approach for patients with HCC, including recurrent or unresectable tumors.
authors.affiliation: Yoji Kishi, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Tomoo Kosuge, Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Kishi
authors.affiliation: Yoji Kishi, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Tomoo Kosuge, Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Yoji Kishi, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Tomoo Kosuge, Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nara
authors.affiliation: Yoji Kishi, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Tomoo Kosuge, Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Esaki
authors.affiliation: Yoji Kishi, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Tomoo Kosuge, Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
keywords: Conversion therapy; Hepatectomy; Hepatocellular carcinoma; Multidisciplinary treatment; Repeat hepatectomy