Extrahepatic Metastases following Hepatic Resection for Hepatocellular Carcinoma: A Clinicopathological Study

Fujio Makita, Norikazu Kamoshita, Mitsunobu Kobayashi, Yoshinao Mitsugi, Kotaro Iwanami, Naoki Hashimoto, Izumi Takeyoshi^*, Susumu Ohwada^*and Yasuo Morishita^*

Department of Gastroenterological Surgery, National Sanatorium Nishi-Gunma Hospital^*Second Department of Surgery, Gunma University School of Medicine

We analyzed the predisposing factors for extrahepatic metastases following hepatic resection for hepatocellular carcinoma (HCC), and also analized the treatment for the metastases, results with included surgical resection. Extrahepatic metastases occured in eight out of 48 resected HCCs, and these were all initially diagnosed as poorly differentiated HCC. There were no significant predisposing factors such as tumor size, presence of vascular invasion, curativity of the resection or adequacy of the resected margins. Extrahepatic metastases also occurred in patients without intrahepatic recurrence following curative resections. The mean interval from surgery to the occurrence of metastases was 15. 4 months. Metastatic sites included the abdominal lymph nodes (3), the lungs (2), the adrenal gland (2), and the omentum (1). Four extrahepatic metastases were resected including the lymph nodes (2), the adrenal gland (1) and the omentum (1). Median survival of patients who could undergo resection of extrahepatic metastases was significantly longer compared to patients who could not (544 vs 116 days, respectively). In conclusion, surgical resection of extrahepatic metastases is the treatment of choice when (1) they are solitary, (2) there is no recurrence in the remnant liver, or (3) if the metastasis in the remnant liver can be well controlled.

Key words
hepatocellular carcinoma, hepatectomy, extrahepatic metastasis of hepatocellular carcinoma

Reprint requests
Fujio Makita Department of Gastroenterological Surgery, National Sanatorium Nishi-Gunma Hospital 2854 Kanai, Sibukawa, 377-0027 JAPAN

Accepted
April 28, 1999

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