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Resection of Peritoneal Implantation From Hepatocellular Carcinoma

From the Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Correspondence: Address correspondence and reprint requests to: Miin-Fu Chen, MD, FACS, Department of Surgery, Chang Gung Memorial Hospital, 5 Fu-Hsing St., Kwei-Shan, Taoyuan, Taiwan; Fax: 886-3-3285818; E-mail: chenmf{at}adm.cgmh.org.tw

Background: Peritoneal implantation is a rare presentation of hepatocellular carcinoma (HCC). This article presents the clinical features and surgical outcomes of 16 patients with HCC in whom isolated peritoneal implantation from HCC was found and who underwent surgical resection.

Methods: From 1988 to 2000, 16 patients with HCC after hepatic resection who underwent resection of peritoneal implantation of HCC were retrospectively reviewed.

Results: Four hundred sixty-five of 749 patients (62.1%) had recurrence of HCC after hepatic resection. Sixteen (3.4%) developed isolated peritoneal implantation and underwent resection. During the detection of the peritoneal implantation, the alfa fetoprotein level was increased in 13 of these 16 patients. Five of 15 patients had a peritoneal mass discovered by ultrasonography, and 14 of 15 patients had a mass discovered by computed tomography. The follow-up period ranged from 2.1 to 81.6 months (median, 16 months). The median disease-free and overall survivals of the 16 patients were 7.89 and 15.98 months, respectively.

Conclusions: Peritoneal implantation occurs infrequently in posthepatectomy patients. Increased alfa fetoprotein values after hepatic resection should suggest recurrence of HCC. Computed tomography is superior to ultrasonography in detection of peritoneal implantation from HCC. Surgical resection of peritoneal implantation from HCC might prolong survival in selected patients.

Key Words: Carcinoma • Hepatocellular • Peritoneal • Implantation

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