The tumor volume doubling time of 27 recurrent hepatocellular carcinoma nodules measuring < or = 2.0 cm in diameter discovered after hepatectomy in 19 patients was analyzed by ultrasonography for 31 to 331 days. The tumor volume doubling time ranged from 39 to 420 days before specific treatment, with a mean of 112 days and a median of 80 days. It correlated with age and intrahepatic site of recurrence, which was sometimes the same lobe as that of the prior hepatocellular carcinoma, sometimes not. The tumor volume doubling time also tended to correlate with hepatitis C antibody status and initial tumor diameter. The tumor volume doubling time was, however, independent of sex, hepatitis B surface antigen status, number of recurrent tumors, initial serum alpha-fetoprotein level, interval between hepatectomy and recurrence detection, and associated liver disease. On the basis of the shortest tumor volume doubling time of the recurrent hepatocellular carcinoma nodules, we recommend that US and/or CT be performed at least every four months to screen for small recurrent carcinomas in postoperative patients.