title: Microvascular invasion patterns affect survival in hepatocellular carcinoma patients after second hepatectomy.
abstract: BACKGROUND
  Microvascular invasion (MVI) is an important risk factor for survival of patients with hepatocellular carcinoma (HCC) after hepatectomy. However, its impact on patients with recurrent HCC who receive a second hepatectomy is unknown.
  
  
  METHODS
  We enrolled 167 patients with HCC who underwent a second hepatectomy because of intrahepatic recurrences. We compared the patients' demographic, tumor, and pathologic characteristics with 766 cases of original hepatectomy. We analyzed the possible risk factors for survival after the first and second hepatectomies and the influence of different MVI patterns on patients' survival after the second hepatectomy.
  
  
  RESULTS
  The median overall survival was comparable between the first and second hepatectomy groups, 34 (3-84) mo versus 27 (3-57) mo, P = 0.09. For patients who underwent a first hepatectomy, the presence of macro-VI or MVI, an early recurrence pattern, and a total tumor diameter >5 cm were independent risk factors. For survival after the second hepatectomy, MVI patterns that were positive-positive or negative-positive and a total recurrent tumor diameter >5 cm were significant risk factors for survival.
  
  
  CONCLUSIONS
  A second hepatectomy provides satisfying survival for patients with intrahepatic recurrence of HCC after the initial operation. Different MVI patterns affect survival after the second hepatectomy. Because MVI represents the biological behavior of HCC, we place a high premium on the clinical value of MVI after each hepatectomy.
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Yi-fu
authors.initials: YF
authors.lastname: Hou
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China. Electronic address: yourwyg@163.com.
authors.forename: Yong-gang
authors.initials: YG
authors.lastname: Wei
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Jia-yin
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Tian-fu
authors.initials: TF
authors.lastname: Wen
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Ming-qing
authors.initials: MQ
authors.lastname: Xu
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Lv-nan
authors.initials: LN
authors.lastname: Yan
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Ke-fei
authors.initials: KF
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hepatectomy; Hepatocellular carcinoma; Microvascular invasion; Recurrence