Abstract

Intrahepatic (IH) metastasis is more frequent but extrahepatic (EH) metastasis results in worse prognosis and proper treatment on IH and EH metastasis is essential for improving the long-term survival. The purpose of this report is to review the current experience of EH metastasectomy and also to review the results of re-hepatectomy on IH metastasis after hepatectomy of HCC. EH metastasis can occur in lung, lymph nodes, bone, adrenal gland and brain in frequency. Indications of EH metastatectomy of HCC are 1) cured or controlled IH lesion, 2) acceptable operation risk, 3) complete removal of EH lesions seems possible. After lung metastasectomy, 5-year survival rates in previous reports are 23-67% according to the indications. The poor prognosis factors after lung metastasectomy are short disease-free interval between hepatectomy and lung resection, high alpha-fetoprotein. In selected patients with EH metastasis of HCC, long-term survival can be achieved by proper and aggressive surgery. The 5-year recurrence rate after hepatectomy of HCC ranges 60-100% and more than half of them is IH recurrence. IH recurrence can be classified to IH metastasis and multicentric occurrence (MO) by mode of recurrence, and MO is known to be related to HCV infection, long disease-free interval and better survival. Though it is impossible to discriminate IH metastasis and MO, re-hepatectomy should be considered in patients with single nodule recurrence and with more than 1-year of disease-free survival after hepatectomy of HCC.

• Keywords: Hepatocellular carcinoma;Hepatectomy;Metastasectomy