The significance of surgical resection for pulmonary metastasis from hepatocellular carcinoma.
BACKGROUND
Pulmonary metastasis, which is the most common type of extrahepatic recurrence of hepatocellular carcinoma (HCC), has been considered unsuitable for surgical resection because most pulmonary metastases are multiple. Until now there have been few reports about surgical resection for pulmonary metastasis from HCC. The aim of the present study was to evaluate the significance of surgical resection for pulmonary metastasis from HCC.


METHODS
Among 615 patients who underwent radical hepatic resection for HCC in our hospital over the past 15 years, 8 patients who had developed 1 or 2 pulmonary metastases underwent pulmonary resection for the pulmonary metastases (resection group), the other 6 patients who had developed 1 or 2 pulmonary metastases did not undergo pulmonary resection (nonresection group). The clinicopathologic features and long-term prognosis of the resection group were examined and compared with those of the nonresection group.


RESULTS
In the resection group, although intrahepatic recurrences were present before the diagnosis of pulmonary metastasis in 4 patients, they were well controlled by repeated transarterial chemoembolization and/or further hepatic resections. The average survival periods after the pulmonary resection and after the initial hepatic resection were 29 months (range, 5-80 mo) and 61 months (range, 24-133 mo), respectively. No patients in the resection group showed pulmonary recurrence after the pulmonary resection, and the cause of death of the patients in the resection group was not pulmonary metastasis. The survival rate of patients in the resection group was significantly better than that in the nonresection group.


CONCLUSIONS
It may be concluded that surgical resection for pulmonary metastasis from HCC might be beneficial in selected patients.
Tomimaru
Yoshito
Y
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
Sasaki
Yo
Y
Yamada
Terumasa
T
Eguchi
Hidetoshi
H
Takami
Koji
K
Ohigashi
Hiroaki
H
Higashiyama
Masahiko
M
Ishikawa
Osamu
O
Kodama
Ken
K
Imaoka
Shingi
S
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome