title: Extrahepatic recurrence of hepatocellular carcinoma after curative hepatic resection.
abstract: OBJECTIVE
  This study was designed to compare the recurrence patterns after curative hepatectomy, to compare the prognosis according to the initial site of metastasis, and to investigate the independent predictive factors associated with extrahepatic recurrence in hepatocellular carcinoma (HCC) patients after curative hepatectomy.
  
  
  METHODS
  From January 2000 to July 2009, 307 patients underwent curative hepatectomies for HCC at our institution; 152 patients showed recurrences. Patients were divided into 2 groups according to their initial recurrence site: the intrahepatic recurrence (IHR) group and extrahepatic recurrence (EHR) group. The IHR group was comprised of 111 patients and the EHR group was comprised of 41 patients. The study investigated the preoperative, intraoperative, and postoperative factors related to the recurrence pattern retrospectively and compared the prognoses of the patients.
  
  
  RESULTS
  A five-year survival rate after an initial recurrence was lower in the EHR group (21.5%) than the IHR group (36.3%) (p<0.001). The preoperative alpha-fetoprotein (AFP) level was an independent risk factor for extrahepatic recurrence (p=0.014).
  
  
  CONCLUSIONS
  Patients with a preoperative AFP level greater than 200 ng/ml have a higher incidence of extrahepatic metastases after a curative resection of HCC. Increased level of preoperative AFP is an indication for a short-term follow up hepatectomy.
authors.affiliation: Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Jangmoo
authors.initials: J
authors.lastname: Byeon
authors.affiliation: Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Eung-Ho
authors.initials: EH
authors.lastname: Cho
authors.affiliation: Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Sang Bum
authors.initials: SB
authors.lastname: Kim
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Choi
keywords: Hepatectomy; Hepatocellular carcinoma; Recurrence