These results suggest that the prognostic impact of tumor size may be underestimated in the current version of the AJCC staging system and that solitary HCC staging could be improved with inclusion of tumor size cutoff of 5 cm in HBV-associated patients. Further validation is necessary with multicenter studies.

Salvage liver transplantation has been performed for recurrent hepatocellular carcinoma (HCC) or deterioration of liver function after primary liver resection. Because prior liver resection per se is an unfavorable condition for living donor liver transplantation (LDLT), we assessed the technical feasibility of LDLT after prior hepatectomy, and we compared the outcome of salvage LDLT with that of primary LDLT in HCC patients. Of 342 patients with HCC, 17 (5%) underwent salvage LDLT, with 5 having undergone prior major liver resection and 12 prior minor resection. During salvage LDLT, 12 patients received right lobe grafts, 3 received left lobe grafts, and 2 received dual grafts. There was 1 incident (5.9%) of perioperative mortality. Recipient operation time was not prolonged in patients undergoing salvage LDLT, but bleeding complications occurred more frequently than in patients undergoing primary LDLT. Overall survival rates after salvage LDLT were similar to those after primary LDLT, especially when the extent of recurrent tumor was within the Milan criteria. These results indicate that every combination of prior hepatectomy and living donor liver graft is feasible for patients undergoing salvage LDLT, and the acceptable extent of HCC for salvage LDLT is equivalent to that for primary LDLT. Liver Transpl 13:741-746, 2007. © 2007 AASLD.Received May 31, 2006; accepted February 9, 2007. See Editorial on Page 636Salvage liver transplantation (LT) has been performed for recurrence of hepatocellular carcinoma (HCC) or for deterioration of liver function after primary liver resection for HCC. Questions arise, however, regarding the technical feasibility of salvage LT in patients who have undergone prior liver surgery. Because initial liver resections in these patients are usually minor in extent, performing deceased donor whole liver graft implantation is not regarded as a contraindication. In contrast, prior performance of a major liver resection, such as right lobectomy, makes subsequent recipient hepatectomy technically difficult. To date, only a small number of salvage LT operations after major liver resection have been reported. 1,2 Living donor liver transplantation (LDLT) can also be performed for salvage. Although prior minor hepatectomy is acceptable for salvage LDLT, there have been no reports to date of salvage LDLT after major hepatectomy. Moreover, the extent of recurrent HCC eligible for salvage LT is not known.To assess the technical feasibility and indication of salvage LDLT for recurrent HCC, we retrospectively assessed our experience performing these surgical procedures over 10 years. We especially analyzed the outcome of various combinations of prior major hepatectomy and graft types in patients undergoing LDLT for recurrent HCC after prior liver resection. MATERIALS AND METHODS Patient SelectionFrom February 1997 to March 2006, a total of 1,049 cases of adult LDLT have been performed in our institution, 3,4 with 342 recipients (32.6%) diagnosed as havAbbreviations: HCC, hepatocellular carcino...