Surgical Treatment of Postoperative Abdominal Metastases of Hepatocellular Carcinoma: 10-Year Experience in a Single Center

Figures & data

Figure 1 Patient flow diagram.

Table 1 Clinicopathologic Characteristics of the 15 Patients with Resected Peritoneal Dissemination

Case	Operation Time	Age (Years)	Sex	ECOG	Child-Pugh Grade	Site of Recurrence	Tumor Number	Metastatic Tumor Size (cm)	Pathological Type	Intrahepatic Recurrence	Treatment	Blood Loss (mL)	Differentiation
1	2017.06	60	Male	0	A	Mesentery	1	10.0	HCC	No	Resection of implantation	200	Well
2	2017.03	49	Male	1	A	Omentum	1	3.0	HCC	Yes	Liver transplantation + Resection of implantation	1000	Moderate
3	2015.12	55	Male	1	A	Abdominal wall	3	1	HCC	No	Resection of implantation	100	Moderate
4	2012.04	57	Male	0	A	Omentum	1	6	HCC	No	Resection of implantation	100	Moderate
5	2012.02	60	Male	0	A	Mesentery	2	4	HCC	Yes	Liver cancer resection + Resection of implantation	400	Moderate
6	2012.11	68	Male	0	A	Mesentery	1	2.5	HCC	No	Resection of implantation	100	Poor
7	2010.04	27	Male	0	A	Omentum	1	7	HCC	Yes	Liver cancer resection + Resection of implantation	300	Moderate
8	2012.11	47	Male	0	A	Mesentery	2	6.8	HCC	No	Resection of implantation + Segmental resection of jejunum	300	Moderate
9	2010.08	57	Male	0	A	Omentum	1	3.6	HCC	Yes	Liver cancer resection + Resection of implantation	400	Moderate
10	2015.05	51	Male	0	A	Mesentery + rectum	2	1.8	HCC	No	Resection of implantation + Partial rectal resection	100	Moderate
11	2017.03	53	Male	0	A	Omentum	2	5.5	HCC	No	Resection of implantation	20	Poor
12	2017.04	61	Male	1	A	Omentum	3	3.3	HCC	No	Resection of implantation	100	Poor
13	2017.11	47	Male	1	A	Right colon	2	1	HCC	Yes	Resection of implantation + liver cancer resection+Right colectomy	400	Moderate
14	2020.04	56	Male	0	A	Omentum	1	2.1	HCC	No	Resection of implantation	100	Poor
15	2017.01	46	Male	0	A	Omentum	4	1.2	HCC	Yes	Resection of implantation	1500	Moderate

Abbreviation: ECOG, Eastern Cooperative Oncology Group.

Table 2 Laboratory Data of the 15 Patients with Resected Peritoneal Dissemination

Case	Hb (g/L)	HBsAg	PT (Sec)	Albumin (g/L)	Bil (T) (μmol/L)	ALT (U/L)	AST (U/L)	AFP (μg/L)
1	156	+	11.4	40.0	15.6	11	15	1.6
2	164	+	12.9	51.5	34	31	33	5.2
3	151	+	11.2	46.0	14.7	32	37	268.9
4	162	+	11.4	39.5	11.2	18	13	2.7
5	143	–	12.3	39.3	10.3	24	23	3.4
6	119	+	12.7	38.9	11.0	12	16	136.5
7	143	+	10.7	42.0	8.3	15	13	423.6
8	136	+	11.6	38.9	11.2	42	40	564.3
9	126	+	12.3	39.9	7.9	23	21	615.2
10	137	+	11.4	40.2	6.3	12	16	113.6
11	129	+	11.6	41.9	5.6	22	26	672.7
12	134	–	12.6	38.7	24.8	21	53	37.9
13	151	–	11.1	38.8	6.0	16	17	292.1
14	147	+	11.6	40.0	9.0	14	20	2411.2
15	132	–	12.6	43.5	8.6	31	45	85.9

Abbreviations: Hb, hemoglobin; PT, prothrombin time; Bil, bilirubin; T, total; ALT, alanine aminotransferase; AST, aspartate aminotransferase; AFP, alfa fetoprotein.

Table 3 Pathological Characteristics of the First Surgery

Case	Size(cm)	Treatment	Differentiation	Satellite Lesions	MVI	Liver Capsule	Section Margin (cm)	Stage of Hepatic Fibrosis	Rupture
1	6.5	Right lobectomy	Well	+	M1	Complete	>1	S3	No
2	4.8	Left lateral segmentectomy	Moderate	–	M1	Complete	<1	S4	No
3	6.5	Liver transplantation	Moderate	+	M0	Complete	>1	S4	No
4	4.5	Left lobectomy	Moderate	–	M1	Complete	>1	S2	No
5	2.5	Local hepatectomy	Moderate	–	M1	Complete	<1	S2	No
6	1.8	Local hepatectomy	Poor	–	M2	Broken	>1	S3	No
7	3.2	Left lateral segmentectomy	Moderate	–	M1	Complete	>1	S2	No
8	4.5	Right posterior lobectomy	Moderate	–	M2	Broken	>1	S2	Yes
9	3.0	Left lobectomy	Moderate	–	M1	Complete	>1	S2	No
10	2.5	Left lateral segmentectomy	Moderate	–	M2	Complete	>1	S3	No
11	8.5	Liver transplantation	Moderate	–	M2	Complete	>1	S4	No
12	5.5	Liver transplantation	Poor	+	M2	Broken	>1	S3	No
13	5.7	Local hepatectomy	Moderate	–	M1	Complete	>1	S3	Yes
14	2.5	Left caudate lobectomy	Poor	–	M0	Complete	<1	S2	No
15	4.5	Local hepatectomy	Poor	–	M1	Complete	>1	S3	No

Abbreviation: MVI, microvascular invasion.

Figure 2 Clinical picture of patient 1. (A) Giant metastatic tumor of mesentery; (B) Computed tomography (CT) images; (C) Tumor section specimen; (D) Arterial dominant phase of CT shows arterial enhancement of nodule measuring 10.0 cm in diameter.

Figure 3 Clinical picture of patient 4. (A) Giant metastatic tumor of omentum; (B) Horizontal plane of magnetic resonance images; (C) Tumor section specimen; (D) Coronal plane of magnetic resonance imaging.

Table 4 Postoperative Survival of the Patients

Case	Treatment of Re-Recurrence	DFS (m)	OS (m)	Status
1	–	43.3	43.3	Free of disease
2	Sorafenib+Lenvatinib	9.6	34.3	Dead
3	Sorafenib+Regorafenib	5.5	47.6	Dead
4	Sorafenib	46.5	94.2	Dead
5	Sorafenib	11.3	15.5	Dead
6	Sorafenib	12.3	16.8	Dead
7	–	130.3	130.3	Free of disease
8	Sorafenib	4.5	9.4	Dead
9	None	6.5	14.3	Dead
10	Sorafenib	4.5	18.6	Dead
11	Sorafenib	5.3	14.3	Dead
12	Sorafenib+Regorafenib	4.3	24.3	Dead
13	Sorafenib	2.3	12.2	Dead
14	–	9.4	9.4	Free of disease
15	Sorafenib+Apatinib	6.3	19.2	Dead

Abbreviations: DFS, disease-free survival; OS, overall survival.

Figure 4 The survival rate after resection of the abdominal metastases.

Abbreviations: DFS, disease-free survival; OS, overall survival.

Table 5 Median Survival of Abdominal Metastases of Hepatocellular Carcinoma in the Literature

No	Author	n	Area	Year	5-Year Os	Median Survival (Months)
1	Yeh et al^Citation9	16	Taiwan	2002	-	16.0
2	Lin et al^Citation14	8	Taiwan	2009	-	13.8
3	Hashimoto et al^Citation15	9	Japan	2012	42.0%	-
4	Takemura et al^Citation16	32	Japan	2014	39.0%	34.5
5	Kow et al^Citation17	13	Singapore	2012	48.0%	33.0

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