Distant metastatic recurrence after hepatic resection for hepatocellular carcinoma

To identify clinicopathologic features of distant metastatic recurrence (DMR) after hepatic resection for hepatocellular carcinoma, we investigated 352 recurrent patients. Of them, 261 with only intrahepatic recurrence were compared with 91 with DMR. Between two groups, there was significantly difference with respect to preoperative liver function, positive tests for protein induced by vitamin K absence or antagonist-II (PIVKA-II), major resection, tumor-free interval, tumor diameter, extrahepatic progression of the tumor, single nodular configuration, and portal vein invasion. Survival rates at 1 and 5 years after intrahepatic recurrence were 73% and 17%, while these were 57% and 18% when recurrences were DMR (p = .0362). DMR was frequent when a resected tumor was large, extrahepatic, ill defined or multinodular or associated with portal vein invasion, good preoperative liver function, or PIVKA-II positivity. Such patients should receive particularly careful follow-up during the first 2 years after hepatic resection focusing on early detection of DMR.