title: Pulmonary metastasectomy for metastasized hepatocellular carcinoma after liver resection and liver transplantation: a single center experience.
abstract: BACKGROUND
  The role of surgery in the treatment of metastasized hepatocellular carcinoma (HCC) remains uncertain. We here report our single centre experience with pulmonary metastasectomy (PM) for metachronous HCC metastases to the lung following curative liver resection (LR) and liver transplantation (LT), respectively.
  
  
  METHODS
  Of 270 patients with HCC being treated by LR or LT at the University Hospital of Leipzig between January 1996 and July 2014, PM was performed in the follow up of 10 patients because of metachronous pulmonary HCC metastases. We retrospectively analyzed demographic and clinicopathological factors as well as the outcome after primary and secondary tumor treatment in these patients.
  
  
  RESULTS
  Following LR/LT and metastasectomy, respectively, mean overall survival was 4.58 ± 0.84 years and 2.4 ± 0.69 years. Postoperative morbidity after primary and secondary tumor treatment was 30 % and 20 %, respectively. Perioperative 30-day mortality was 0 %. Univariate analysis suggest tumor grading (p < 0.05), and a disease free-intervall > 1 year (p = 0.02) as significant prognostic parameters for survival in our collective.
  
  
  CONCLUSIONS
  PM can be performed safely with a reasonable morbidity even in immunosuppressed patients after LT. Further studies are needed to evaluate whether PM can increase long-term survival in selected patients with resectable metastases and represents an alternative or additive treatment modality to the protein kinase inhibitor sorafenib.
authors.affiliation: Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany.
authors.forename: H M
authors.initials: HM
authors.lastname: Hau
authors.affiliation: Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schmelzle
authors.affiliation: Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Benzing
authors.affiliation: Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Ascherl
authors.affiliation: Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany.
authors.forename: H M
authors.initials: HM
authors.lastname: Tautenhahn
authors.affiliation: Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Gäbelein
authors.affiliation: Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Eichfeld
authors.affiliation: Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bartels
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods / Q000401:mortality*; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome