title: Pulmonary resection of metastatic hepatocellular carcinoma after liver transplantation.
abstract: BACKGROUND
  The primary limitation to long-term survival after liver transplantation for hepatocellular carcinoma (HCC) is tumor recurrence. Pulmonary resection for metastatic HCC prolongs survival in patients after liver resection; this success may be extrapolated to the transplant population in the treatment of pulmonary recurrence of HCC after liver transplantation.
  
  
  METHODS
  Between January 2000 and January 2006, five patients who underwent orthotopic liver transplantation for HCC were identified on routine follow-up with pulmonary metastases. They all underwent resection of the pulmonary recurrence of HCC and were studied retrospectively.
  
  
  RESULTS
  The time from transplant to diagnosis of pulmonary recurrence ranged from 150 days to 880 days, with a mean of 500 days. All of the recurrences were amenable to complete resection. Two patients developed a second tumor. One patient had a new primary of squamous cell carcinoma. Another patient had a bony recurrence of HCC in the ninth rib. Four of the patients are still alive, and the fifth died from hepatic failure. The stage of the tumor in the explanted liver ranged from II to IVb. The average time for survival from transplant was 44 months, and the average time from pulmonary resection was 27.5 months.
  
  
  CONCLUSIONS
  The patients in this study demonstrate survival times similar to patients with HCC treated with liver resection. Although the size of the study population is small, the long survival times in the patients is encouraging. The advanced stage and histologically invasive nature of the primary tumors may predispose to subsequent pulmonary recurrence.
authors.affiliation: Department of Cardiothoracic Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA. mbates@stanford.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bates
authors.forename: Emily
authors.initials: E
authors.lastname: Farkas
authors.forename: David
authors.initials: D
authors.lastname: Taylor
authors.forename: P Michael
authors.initials: PM
authors.lastname: McFadden
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome