Journal of Gastrointestinal Surgery

, Volume 16, Issue 8, pp 1516–1523

Role of Operative Therapy in Non-cirrhotic Patients with Metastatic Hepatocellular Carcinoma

  • Victor Zaydfudim
  • Rory L. Smoot
  • Clancy J. Clark
  • Michael L. Kendrick
  • Florencia G. Que
  • Michael B. Farnell
  • David M. Nagorney
Original Article



We investigated the role of operative therapy in non-cirrhotic patients who developed metastatic hepatocellular carcinoma (HCC).


This retrospective cohort study included consecutive non-cirrhotic patients with metastatic HCC after a prior hepatectomy treated between 1990 and 2009. Patients were stratified by operative therapy (resection, ablation, transcatheter therapy). Kaplan–Meier analyses with log-rank comparisons tested effects of operative therapy on overall survival (OS) and progression-free survival (PFS).


Of 195 non-cirrhotic patients treated for HCC during the study period, 98 [median age 65, interquartile range (IQR) 53–71; 55 % male] subsequently developed metastatic HCC (55 intrahepatic only). Median time to development of metastases after the index operation was 10 months (IQR 5–20 months); median number of metastases was 3 (IQR 2–7). Half of these patients (n = 50) underwent operative treatment of metastases; 20 (40 %) underwent metastasectomy, 18 (36 %) ablation, and 12 (24 %) transcatheter therapy. Operative therapy was associated with improved OS (p < 0.001). Resection or ablation was associated with improved PFS and OS compared to transcatheter therapy (all p ≤ 0.006). Nine patients (seven resection, two ablation) are disease free at a median of 50 months (IQR 24–80 months) posttreatment.


Resection and ablation are associated with an improved PFS and long-term OS and should be considered in select patients with metastatic HCC.


Hepatocellular carcinoma Recurrence Metastasis HCC Metastasectomy Sorafenib Outcome Resection Ablation 


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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Victor Zaydfudim
    • 1
  • Rory L. Smoot
    • 1
  • Clancy J. Clark
    • 1
  • Michael L. Kendrick
    • 1
  • Florencia G. Que
    • 1
  • Michael B. Farnell
    • 1
  • David M. Nagorney
    • 1
  1. 1.Division of Gastroenterologic and General SurgeryMayo ClinicRochesterUSA

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