OBJECTIVE Although few hepatectomy patients develop unexpected early diffuse and multinodular recurrence in the remnant liver, the prognosis in such cases is often dismal. The aim of this study was to evaluate the risk factors of early disseminated multinodular hepatocellular carcinoma (HCC) recurrence within 3 months after liver resection for solitary HCC. METHODS Eighty-four patients who were diagnosed with recurrent HCC within 3 months after hepatectomy for solitary HCC were retrospectively reviewed. Disseminated HCC recurrence was defined as more than 10 tumors in both lobes and total tumor size >10 cm. RESULTS Preoperative α-FP level, incidence of poor tumor grade, and presence of portal vein tumor thrombosis were higher in the patients with disseminated HCC recurrence than in those without disseminated HCC recurrence (P < 0.05). Multivariate analysis showed that α-FP >1,000 ng/dL was a predisposing factor of disseminated HCC recurrence within 3 months after liver resection. The overall survival rate for patients without disseminated HCC recurrence was higher than that for patients with disseminated HCC recurrence (P < 0.001). CONCLUSIONS Early disseminated multinodular HCC recurrence in hepatectomy patients was associated with preoperative α-FP >1,000 ng/dL. Such patients should be frequently evaluated for the early detection of recurrent HCC for early intervention.