Abstracts

2009 HPB  
While several Asian studies have shown promising results for second resection for recurrent hepatocellular carcinoma (HCC), there are no Western series on this topic. The purpose of this study was to determine the outcome of patients undergoing a second hepatic resection for recurrent HCC at a Western center and to identify prognostic variables. Methods: A retrospective review of all patients undergoing hepatic resection for HCC from 1/1990 to 1/2008 was conducted. Patients underwent second
more » ... ction if they had a single tumor on imaging, Child's A liver function, platelets > 100 000 and no extrahepatic disease. Results: During this period, 487 patients underwent resection with 221 having documented recurrence. Of these, 30 underwent second resection. Underlying liver disease included HBV (n = 18), HCV (n = 6), none (n = 4), and other (n = 2). Mean tumor size was 9.6 cm at first resection and 4.0 cm at second resection. Median interval between first resection and recurrence was 15.5 months. There were no perioperative mortalities and 1, 3, and 5 years survivals were 88%, 65%, and 65%. Recurrence rate at 3 year was 80%. Univariate predictors of survival included < 1year interval from first resection to recurrence, gross vascular invasion at second resection, tumor > 5cm at second resection, and blood transfusion at second resection. Multivariate analysis found gross vascular invasion at second resection as the only independent predictor of mortality (HR 76.9, P = 0.002). Patients without gross vascular invasion at 2nd resection had median survival of 76.8 months and 5 year survival of 74%. Conclusions: Second resection for recurrent HCC has excellent outcomes in well selected patients. Gross vascular invasion is the only independent predictor of outcome after second resection.
doi:10.1111/j.1477-2574.2008.00035.x fatcat:3xvrc3duzjfzbiartcgkmyvxga