Parietal and peritoneal localizations of hepatocellular carcinoma: is there a place for a curative surgery?

BACKGROUND: The clinical course of peritoneal and parietal recurrence of hepatocellular carcinoma (HCC-PPL) is not well known. METHODS: Twenty-eight patients with a histologically proven HCC-PPL were analyzed out of a series of 515 patients operated for HCC (group 1). The risk factors, histological features, growing dynamic and results of surgical treatment were analyzed and compared with patients having other extrahepatic localizations of HCC (group 2; 26 patients). Survival data were also compared with patients with intrahepatic-only recurrence (group 3; 211 patients). RESULTS: In group 1, a needle tract injury was present in 57.1% and a previous spontaneous rupture in 14.3% of cases. Parietal seeding was generally single, while peritoneal seeding was frequently multiple. Grading was poor in 84.7%, microvascular infiltration was observed in 57.1% and a rapid growth in 55.5% of cases. In Group 2, only 4 out of 26 patients underwent surgery. Survival was significantly better in group 3 than in group 1, and in group 1 than in group 2. CONCLUSIONS: Extrahepatic HCC recurrence is related to an aggressive biology of the cancer; many characteristics of high malignancy are usually present in these cases. After radical surgery for HCC-PPL, an acceptable survival may be obtained.