title: Resection of pulmonary metastases from hepatocellular carcinoma following liver transplantation.
abstract: BACKGROUND
  This study was intended to assess the effect of resection of pulmonary metastasis (PM) of hepatocellular carcinoma (HCC) after liver transplantation (LT). No effective treatment modality exists for PM-HCC, and little is known about the posttransplant outcomes of pulmonary metastasectomy (PMT).
  
  
  METHODS
  Of 587 adult LT recipients diagnosed with HCC, 43 had PM-HCC. We retrospectively compared outcomes in 23 patients who underwent PMT and 20 who did not. PMT was precluded in ten patients in the non-PMT group by multiple (usually ≥ 5) lung nodules, in nine by lung nodules with concurrent or residual extrapulmonary metastasis, and in one by comorbidity.
  
  
  RESULTS
  Of the 23 patients in the PMT group, 14 underwent a single session of PMT, 7 underwent 2 sessions each, and 2 underwent 3 sessions each, for a total of 34 sessions. There were no surgery-related deaths or complications. After first PMT, 41 nodules, each 0.2-2.5 cm in diameter, were observed: 1-5 nodules per patient. Every available treatment was provided to patients with post-PMT recurrence and those in the non-PMT group to control pulmonary and extrapulmonary metastases. Patient survival rates before PM diagnosis did not differ between the two groups (p = 0.141). However, 2 year post-PM survival rate was significantly greater in the PMT group (30.6% vs. 0%, p = 0.007), resulting in a significantly greater overall 5 year survival rate (44.7% vs. 12.8%, p = 0.017). Univariate analysis showed no risk factor significantly associated with patient survival after PMT.
  
  
  CONCLUSIONS
  PMT should be performed for resectable PM-HCC because it may provide a chance of long-term survival.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Yong-Hee
authors.initials: YH
authors.lastname: Kim
authors.forename: Dong Kwan
authors.initials: DK
authors.lastname: Kim
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Deog-Bok
authors.initials: DB
authors.lastname: Moon
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Hyeong Ryul
authors.initials: HR
authors.lastname: Kim
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Jeong-Man
authors.initials: JM
authors.lastname: Namgoong
authors.forename: Sam-Youl
authors.initials: SY
authors.lastname: Yoon
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Jung
authors.forename: Seung Il
authors.initials: SI
authors.lastname: Park
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult