title: Long-term survival after pulmonary metastatectomy of hepatocellular carcinoma; treatment outcome or natural history?
abstract: OBJECTIVE
  To evaluate the role of pulmonary metastatectomy in hepatocellular carcinoma.
  
  
  METHODS
  Four hepatocellular carcinoma patients underwent pulmonary metastatectomy. Patients were considered candidates for pulmonary metastatectomy when they met the following criteria; 1) intrahepatic hepatocellular carcinoma was under control or anticipated to be under control in the near future; 2) the metastatic lesions appeared to be amenable to complete resection; 3) there was no metastasis at another site.
  
  
  RESULTS
  The median duration of follow-up was 4.1 (range: 2.4 to 6.0) years. During this period, 1 patient died of pulmonary recurrence 29 months after metastatectomy. The remaining 3 were alive at the time of writing; one for 43 months after metastatectomy without recurrence; another for 72 months with intrahepatic recurrence; and the third for 54 months with extrahepatic recurrence.
  
  
  CONCLUSIONS
  Long-term survival was achieved after pulmonary metastatectomy in highly selected hepatocellular carcinoma patients. However, "highly selected patients" might imply that such patients belong to a special subgroup composed of cases with an intrinsically slow growing tumor biology. Therefore, it is an issue of interest as to whether the long-term survival acquired by these cases results from the pulmonary metastatectomy, or whether it is a reflection of a fate dictated by intrinsic tumor biology.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Geum-Youn
authors.initials: GY
authors.lastname: Gwak
authors.forename: Jun-Oh
authors.initials: JO
authors.lastname: Jung
authors.forename: Sook-Whan
authors.initials: SW
authors.lastname: Sung
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007723:Korea; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D012086:Reoperation; D017741:Survivors