**1. Introduction**

120 Liver Tumors

[16] Jamieson GG, Corbel L, Campion JP, Launois B. Major liver resection without a blood

[17] Makuuchi M, Kosuge T, Takayama T, et al. Surgery for small liver cancers. *Semin Surg* 

transfusion: is it a realistic objective? *Surgery*. 1992; 112: 32-6.

*Oncol*. 1993;9:298–304.

Hepatocellular carcinoma is an important malignancy of global significance. It is the seventh commonest cancer and the fourth leading cause of cancer deaths worldwide (GLOBOCAN, 2008). While hepatectomy remains to be the gold standard for treating HCC, long-term prognosis after curative resection remains unsatisfactory with high incidence of recurrence. The reported cumulative 5-year recurrence rate after curative partial hepatectomy averages above 70% in both Eastern and Western centers and the remnant liver is the commonest site of recurrence (Chong et al., 2011; Ercolani et al., 2003; Poon et al., 2001; Yeh et al., 2002).

Intra-hepatic metastasis from the primary resected tumor and multicentric occurrence of a new tumor in the liver remnant are the two major patterns of intra-hepatic recurrence of HCC. In general, intrahepatic metastasis represented early recurrence (within 1 year after hepatectomy) and is associated with the vascular invasion and the subsequent intrahepatic venous spread while multicentric occurrence is associated with the underlying liver status and represented late recurrence (Jwo et al., 1992; Matsumata et al., 1989; Yamamoto et al., 1998). Although the exact mechanism has not been clarified, many studies had shown that late recurrence was associated with a better survival than early recurrence (Poon et al., 1999; Poon et al., 2000; Shimada et al., 1996).

Appropriate treatment for intrahepatic recurrence is crucial in improving long-term outcome after initial hepatectomy. Increased survival rates after aggressive treatment of post-resection HCC recurrence have been reported (Itamoto et al., 2007; Matsuda et al., 2001; Sugimachi et al., 2001; Tralhao et al., 2007; Wu et al., 2009; Zhou et al., 2010). Currently, various therapeutic modalities such as repeat hepatectomy, local ablation therapy and transcatheter arterial chemoembolization (TACE) have been used to treat recurrent HCC. However, there is no standard strategy for selection among different modalities so far.
