Diffuse intrahepatic recurrence after resection of hepatocellular carcinoma

Background/Aims: An early diffuse type in the pattern of the postoperative intrahepatic recurrence of hepatocellular carcinoma has been recognized. Th e purpose of this study was to elucidate risk factors for diffuse recurrenc e of hepatocellular carcinoma. Methodology: The subjects involved in the present study were 114 patients w ith hepatocellular carcinomas resected in Tenri Hospital during the past 12 years. Univariate analysis was used for retrospective determination of the factors related to diffuse recurrences after surgery in 10 cases among 114 patients. Results: The risk factors linked to diffuse recurrence were microscopical p ortal infiltration (P<0.01), elevated <alpha>-fetoprotein (more than 1000ng /mL) (P<0.05), the absence of preoperative transcatheter arterial embolizat ion (P<0.01), and two or more segmentectomies of the liver (P<0.01). Six of 10 patients with microscopical portal infiltration and elevated <alpha>-fe toprotein (more than 1000ng/mL) had diffuse recurrence (P<0.01). Six of 8 p atients with two Or more segmentectomies without preoperative TAE had diffu se recurrence (P<0.01). Conclusions: When patients with the diagnosis of operable hepatocellular ca rcinoma have portal infiltration and elevated alpha -fetoprotein (more than 1000ng/mL), two or more segmentectomies of the liver without preoperative transcatheter arterial embolization should be avoided.