Third Liver Resection for Re-recurrent Hepatocellular Carcinoma: Assessment of the Prognostic Factors of Long-term Survival.

Background/Aim: Second hepatic resection is a well-established and effective treatment for recurrent hepatocellular carcinoma (HCC). Despite this, the recurrence rate of HCC remains high. The efficacy of third liver resection for re-recurrent HCC is uncertain, and prognostic factors affecting survival after third hepatectomy have not been comprehensively evaluated. This study aimed to investigate the short- and long-term outcomes of third liver resection for re-recurrent HCC and identify prognostic factors affecting survival. Patients and Methods: In total, 27 patients who underwent three liver resections for primary, recurrent, and re-recurrent HCC were retrospectively reviewed. The prognostic factors of long-term survival were evaluated using clinical data including those of previous liver resections. Results: No cases of perioperative mortality after third liver resection for re-recurrent HCC were found. The median overall survival and disease-free survival were 38.3 and 5.8 months, respectively. The 5-year overall survival and disease-free survival rates were 56.8% and 10.9%, respectively. Clinical parameters such as tumor marker level, primary tumor size, and surgical interval of the third liver resection and of the first and second surgeries were significantly associated with long-term survival. Conclusion: The survival rate of third liver resection for re-recurrent HCC in our study was similar to that reported for second and third hepatectomies in previous studies. Clinical information on previous surgeries could be a useful determinant of third liver resection for re-recurrent HCC.