A total of 277 patients with hepatocellular carcinoma (HCC) underwent hepatic resection over a 20-year period. Twelve of 36 patients with recurrence confined to extrahepatic organs underwent surgical resection. There were no complications but one patient died in hospital from secondary intrahepatic recurrence. The 1-, 2and 5-year survival rates for these 12 patients after hepatic d o n were 92, 52 and 26 per cent respectively and were better than those of 24 patients who did not undergo resection for recurrence. The mean survival following resection for recurrent disease was 19.7 months and the longest survival time was nearly 8 years. Secondary recurrence after resection of metastases developed more commonly in the liver than in extrahepatic organs. Among the eight patients who survived for more than 4 months after the second operation, secondary recurrence developed in the liver and extrahepatic organs in eight and four patients respectively. In selected patients with Isolated extrahepatic recurrence of HCC, surgery is effective in controlling extrahepatic disease and offers the only chance of long-term survival.
Hepatocellular carcinoma (HCC) occurs commonly in parts of Africa and the Far East including Hong Kong. It is a highly malignant tumour and a median survival of less than 2 months in untreated patients has been Hepatic resection is usually regarded as the only treatment option with the potential for c ~r e ~. ~.
However, the long-term survival rate after surgery remains low, with 5-year rates of 13-30 per cent reported in different series5-*. Most patients die from tumour recurrence. In a recent reportY of 96 patients who underwent hepatectomy for large HCC, 64 per cent developed recurrence during a median follow-up of 13 months. Intrahepatic disease was found in 49 per cent of patients and 24 per cent had extrahepatic recurrence.
Recent advances in surgical technique'('^" and interventional radiology1*." have significantly improved the outlook of patients with recurrent disease in the liver remnant. On the other hand, treatment options for extrahepatic recurrence are limited. Systemic chemotherap