Repeated resections of extrahepatic metastases after hepatic resection: an aggressive approach to hepatocellular carcinoma.

Survival following curative hepatic resection for hepatocellular carcinoma is limited by a high incidence of recurrence. Resection of extrahepatic recurrences has been shown to prolong survival in selected patients. We report two cases in whom repeated resections of extrahepatic metastases achieved good palliation and survival. The first patient had cerebral, pulmonary and splenic metastases that appeared more than four years following an extended left hepatectomy for a 4-cm hepatocellular carcinoma. Resection of the metastases in the three organs was performed in sequence, and the patient remained alive and asymptomatic 12 months after the metastatic recurrence. The second patient developed pulmonary metastases after an extended right hepatectomy for a 16-cm hepatocellular carcinoma. Following two resections of pulmonary metastases, he was alive and disease-free for seven years. These two cases illustrate that an aggressive surgical approach of repeated resections of extrahepatic recurrences after curative resection of hepatocellular carcinoma can result in long-term survival in selected patients.