Role of surgical resection for pulmonary metastasis of hepatocellular carcinoma

INTRODUCTION:The lung is one of the most important organs affected by metastasis of hepatocellular carcinoma. However, pulmonary metastasectomy for hepatocellular carcinoma has not been well documented. The aim of this study was to evaluate long-term outcome after pulmonary metastasectomy due to metastasis of hepatocellular carcinoma. METHODS:Between January 1998 and December 2008, 41 patients underwent pulmonary metastasectomy. Retrospective reviews of medical records and telephone surveys were conducted to identify risk factors of long-term survival. RESULTS:Median time between a complete remission of hepatocellular carcinoma and pulmonary metastasectomy was 11 (4-105) months. During median 25-month follow-up time after metastasectomy, hepatocellular carcinoma recurred in 33 patients. Overall survival rate was 66.9±10% in all 41 patients and disease free survival was 24.5±10% in 24 patients who had no viable hepatocellular carcinoma in the liver preoperatively. An analysis of recurrence revealed that survival was better in patients whose recurrence was limited to either in the liver or lungs compared to that in patients whose recurrence took place in the distant organ other than the liver or lungs (extrahepatic/extrapulmonary metastasis) (p=0.004, log-rank). CONCLUSIONS:Pulmonary metastasectomy for hepatocellular carcinoma can be performed safely without major morbidity. Recurrence at organs other than the liver or lung was found to result in poor survival, which suggests that a careful search for distant metastasis at other locations is mandatory for patient selection. This study demonstrated that pulmonary metastasectomy can play an important role in selected patients with pulmonary metastasis of hepatocellular carcinoma.