**3.2 Surgical resection**

Recently, the role of resection of extra-hepatic metastasis from hepatocellular carcinoma has been reviewed (Chua & Morris, 2011). From the results reported in the literatures, prolonged survival after surgical resection may be achieved in selected patients with solitary extra-hepatic recurrence at the sites of the abdominal lymph node, adrenal gland, lung, and peritoneum. Surgical resection might be an effective option in patients with one or two isolated extrahepatic metastases if the patient has otherwise good performance status, good hepatic functional reserve, and well-controlled intrahepatic HCC recurrence. However, it might just reflect a group of patients with a more favourable natural course of disease (Chan et al., 2009; Lam et al., 1998; Nakayama et al., 1999; Sakamoto et al., 1999).

Fig. 7. Algorithm protocol for treatment of recurrent HCC
