Published in:
01-07-2012
Resection of Pulmonary Metastases from Hepatocellular Carcinoma following Liver Transplantation
Authors:
Shin Hwang, Yong-Hee Kim, Dong Kwan Kim, Chul-Soo Ahn, Deog-Bok Moon, Ki-Hun Kim, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Hyeong Ryul Kim, Gil-Chun Park, Jeong-Man Namgoong, Sam-Youl Yoon, Sung-Won Jung, Seung Il Park, Sung-Gyu Lee
Published in:
World Journal of Surgery
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Issue 7/2012
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Abstract
Background
This study was intended to assess the effect of resection of pulmonary metastasis (PM) of hepatocellular carcinoma (HCC) after liver transplantation (LT). No effective treatment modality exists for PM-HCC, and little is known about the posttransplant outcomes of pulmonary metastasectomy (PMT).
Methods
Of 587 adult LT recipients diagnosed with HCC, 43 had PM-HCC. We retrospectively compared outcomes in 23 patients who underwent PMT and 20 who did not. PMT was precluded in ten patients in the non-PMT group by multiple (usually ≥5) lung nodules, in nine by lung nodules with concurrent or residual extrapulmonary metastasis, and in one by comorbidity.
Results
Of the 23 patients in the PMT group, 14 underwent a single session of PMT, 7 underwent 2 sessions each, and 2 underwent 3 sessions each, for a total of 34 sessions. There were no surgery-related deaths or complications. After first PMT, 41 nodules, each 0.2–2.5 cm in diameter, were observed: 1–5 nodules per patient. Every available treatment was provided to patients with post-PMT recurrence and those in the non-PMT group to control pulmonary and extrapulmonary metastases. Patient survival rates before PM diagnosis did not differ between the two groups (p = 0.141). However, 2 year post-PM survival rate was significantly greater in the PMT group (30.6% vs. 0%, p = 0.007), resulting in a significantly greater overall 5 year survival rate (44.7% vs. 12.8%, p = 0.017). Univariate analysis showed no risk factor significantly associated with patient survival after PMT.
Conclusions
PMT should be performed for resectable PM-HCC because it may provide a chance of long-term survival.