Appraisal of Surgical Treatment for Pulmonary Metastasis from Hepatocellular Carcinoma

The outcome of pulmonary metastasectomy of hepatocellular carcinoma (HCC) was appraised in this study. Twenty patients with pulmonary metastasis from HCCs undergoing pulmonary resection between 1990 and 2003 were included in this study. They had undergone curative treatment for the primary lesion and were candidates for a pulmonary metastasectomy for complete resection. Among the 20 patients, 13 died: 5 from hepatic failure, 5 from respiratory failure, and 2 from brain metastasis due to recurrence of the HCC. One patient died from cardiac failure without HCC recurrence. At the latest observation, three of the seven survivors were doing well without HCC recurrence, and others survived with recurrence. The overall survival rates after the initial lung surgery were 45.3% at 1 year and 23.8% at 3 years, respectively. The survival rates without recurrence were 32.4% at 1 year and 21.6% at 3 years, respectively. A Kaplan-Meier analysis showed that multiple lung surgeries and a negative histologic finding of the liver cut surface were favorable characteristics for survival without recurrence. In conclusion, the selected patients were Candidates for pulmonary metastasectomy after a curative hepatectomy for HCC and could benefit from the complete resection. Also, repeated pulmonary resections through thoracoscopy could result in the long-term survival of patients with pulmonary recurrence of HCC.