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Resection of Pulmonary Metastases from Hepatocellular Carcinoma following Liver Transplantation

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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.

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References

  1. Hwang S, Lee SG, Belghiti J (2010) Liver transplantation for HCC: its role: Eastern and Western perspectives. J Hepatobiliary Pancreat Sci 17:443–448

    Article  PubMed  Google Scholar 

  2. Lee S, Ahn C, Ha T, Moon D et al (2010) Liver transplantation for hepatocellular carcinoma: Korean experience. J Hepatobiliary Pancreat Sci 17:539–547

    Article  PubMed  Google Scholar 

  3. Hwang S, Moon DB, Lee SG (2010) Liver transplantation and conventional surgery for advanced hepatocellular carcinoma. Transpl Int 23:723–727

    Article  PubMed  Google Scholar 

  4. Todo S, Furukawa H, Japanese Study Group on Organ Transplantation (2004) Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in Japan. Ann Surg 240:451–459

    Article  PubMed  Google Scholar 

  5. Lee SG, Hwang S, Moon DB et al (2008) Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transpl 14:935–945

    Article  PubMed  Google Scholar 

  6. Chen F, Sato K, Fujinaga T et al (2008) Pulmonary resection for metastases from hepatocellular carcinoma. World J Surg 32:2213–2217

    Article  PubMed  Google Scholar 

  7. Kawamura M, Nakajima J, Matsuguma H et al (2008) Surgical outcomes for pulmonary metastases from hepatocellular carcinoma. Eur J Cardiothorac Surg 34:196–199

    Article  PubMed  Google Scholar 

  8. Kwon JB, Park K, Kim YD et al (2008) Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: analysis of prognostic factors. World J Gastroenterol 14:5717–5722

    Article  PubMed  Google Scholar 

  9. Lee CY, Bae MK, Park IK et al (2010) Surgical resection for pulmonary metastasis from hepatocellular carcinoma: analysis of prognosis in relation to primary control. J Surg Oncol 101:239–243

    PubMed  Google Scholar 

  10. Yoon YS, Kim HK, Kim J et al (2010) Long-term survival and prognostic factors after pulmonary metastasectomy in hepatocellular carcinoma. Ann Surg Oncol 17:2795–2801

    Article  PubMed  Google Scholar 

  11. Han KN, Kim YT, Yoon JH et al (2010) Role of surgical resection for pulmonary metastasis of hepatocellular carcinoma. Lung Cancer 70:295–300

    Article  PubMed  Google Scholar 

  12. Kitano K, Murayama T, Sakamoto M et al (2011) Outcome and survival analysis of pulmonary metastasectomy for hepatocellular carcinoma. Eur J Cardiothorac Surg (in press)

  13. Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699

    Article  PubMed  CAS  Google Scholar 

  14. Hwang S, Ahn CS, Kim KH et al (2011) Super-selection of a subgroup of hepatocellular carcinoma patients at minimal risk of recurrence for liver transplantation. J Gastrointest Surg 15:971–981

    Article  PubMed  Google Scholar 

  15. Lee JW, Paeng JC, Kang KW et al (2009) Prediction of tumor recurrence by 18F-FDG PET in liver transplantation for hepatocellular carcinoma. J Nucl Med 50:682–687

    Article  PubMed  Google Scholar 

  16. Kim YK, Lee KW, Cho SY et al (2010) Usefulness 18F-FDG positron emission tomography/computed tomography for detecting recurrence of hepatocellular carcinoma in posttransplant patients. Liver Transpl 16:767–772

    Article  PubMed  Google Scholar 

  17. Yoon DH, Ryoo BY, Ryu MH et al (2010) Sorafenib for recurrent hepatocellular carcinoma after liver transplantation. Jpn J Clin Oncol 40:768–773

    Article  PubMed  Google Scholar 

  18. Toso C, Merani S, Bigam DL et al (2010) Sirolimus-based immunosuppression is associated with increased survival after liver transplantation for hepatocellular carcinoma. Hepatology 51:1237–1243

    Article  PubMed  CAS  Google Scholar 

  19. Schwarz RE, Abou-Alfa GK, Geschwind JF et al (2010) Nonoperative therapies for combined modality treatment of hepatocellular cancer: expert consensus statement. HPB (Oxford) 12:313–320

    Google Scholar 

  20. Kim R, El-Gazzaz G, Tan A, Elson P et al (2010) Safety and feasibility of using sorafenib in recurrent hepatocellular carcinoma after orthotopic liver transplantation. Oncology 79:62–66

    Article  PubMed  CAS  Google Scholar 

  21. Hwang S, Lee SG, Ahn CS et al (2010) A clinical assessment of mycophenolate drug monitoring after liver transplantation. Clin Transplant 24:E35–E42

    Article  PubMed  CAS  Google Scholar 

  22. Hwang S, Lee SG, Ahn CS et al (2008) Prevention of hepatitis B recurrence after living donor liver transplantation: primary high-dose hepatitis B immunoglobulin monotherapy and rescue antiviral therapy. Liver Transpl 14:770–778

    Article  PubMed  Google Scholar 

  23. Yi NJ, Suh KS, Cho JY et al (2007) Recurrence of hepatitis B is associated with cumulative corticosteroid dose and chemotherapy against hepatocellular carcinoma recurrence after liver transplantation. Liver Transpl 13:451–458

    Article  PubMed  Google Scholar 

  24. Faria LC, Gigou M, Roque-Afonso AM et al (2008) Hepatocellular carcinoma is associated with an increased risk of hepatitis B virus recurrence after liver transplantation. Gastroenterology 134:1890–1899

    Article  PubMed  Google Scholar 

  25. Pang RW, Poon RT (2007) From molecular biology to targeted therapies for hepatocellular carcinoma: the future is now. Oncology 72(Suppl 1):30–44

    Article  PubMed  CAS  Google Scholar 

  26. Schwartz M, Roayaie S, Llovet J (2005) How should patients with hepatocellular carcinoma recurrence after liver transplantation be treated? J Hepatol 43:584–589

    Article  PubMed  Google Scholar 

  27. Poon RT, Fan ST, O’Suilleabhain CB et al (2002) Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy. J Am Coll Surg 195:311–318

    Article  PubMed  Google Scholar 

  28. Kothary N, Bartos JA, Hwang GL et al (2010) Computed tomography-guided percutaneous needle biopsy of indeterminate pulmonary pathology: efficacy of obtaining a diagnostic sample in immunocompetent and immunocompromised patients. Clin Lung Cancer 11:251–256

    Article  PubMed  Google Scholar 

  29. Ng YL, Patsios D, Roberts H et al (2008) CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less. Clin Radiol 63:272–277

    Article  PubMed  CAS  Google Scholar 

  30. Lee YT, Hwang S, Lee SG et al (2010) Living-donor liver transplantation in patients with concurrent active tuberculosis at transplantation. Int J Tuberc Lung Dis 14:1039–1044

    PubMed  CAS  Google Scholar 

  31. Yeganeh M, Finn RS, Saab S (2009) Apparent remission of a solitary metastatic pulmonary lesion in a liver transplant recipient treated with sorafenib. Am J Transplant 9:2851–2854

    Article  PubMed  CAS  Google Scholar 

  32. Hata M, Tokuuye K, Sugahara S et al (2007) Proton beam therapy for aged patients with hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 69:805–812

    Article  PubMed  Google Scholar 

  33. Li C, Zhang F, Zhang W et al (2010) Feasibility of (125) I brachytherapy combined with sorafenib treatment in patients with multiple lung metastases after liver transplantation for hepatocellular carcinoma. J Cancer Res Clin Oncol 136:1633–1640

    Article  PubMed  CAS  Google Scholar 

  34. Kim TS, Lim HK, Lee KS et al (2003) Imaging-guided percutaneous radiofrequency ablation of pulmonary metastatic nodules caused by hepatocellular carcinoma: preliminary experience. AJR Am J Roentgenol 181:491–494

    PubMed  Google Scholar 

  35. Tomimaru Y, Sasaki Y, Yamada T et al (2006) The significance of surgical resection for pulmonary metastasis from hepatocellular carcinoma. Am J Surg 192:46–51

    Article  PubMed  Google Scholar 

  36. Nakagawa T, Kamiyama T, Nakanishi K et al (2006) Pulmonary resection for metastases from hepatocellular carcinoma: factors influencing prognosis. J Thorac Cardiovasc Surg 131:1248–1254

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors thank RNs Eun-Joo Sim and Hyeon-Mi Ryu for their contributions toward data collection.

Conflicts of interest

None.

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Authors and Affiliations

  1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138–736, Korea

    Shin Hwang, Chul-Soo Ahn, Deog-Bok Moon, Ki-Hun Kim, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Jeong-Man Namgoong, Sam-Youl Yoon, Sung-Won Jung & Sung-Gyu Lee

  2. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Yong-Hee Kim, Dong Kwan Kim, Hyeong Ryul Kim & Seung Il Park

Authors
  1. Shin Hwang
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  2. Yong-Hee Kim
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  3. Dong Kwan Kim
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  4. Chul-Soo Ahn
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  14. Sung-Won Jung
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  16. Sung-Gyu Lee
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Corresponding author

Correspondence to Sung-Gyu Lee.

Additional information

S. Hwang and Y.H. Kim contributed equally to this work.

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Hwang, S., Kim, YH., Kim, D.K. et al. Resection of Pulmonary Metastases from Hepatocellular Carcinoma following Liver Transplantation. World J Surg 36, 1592–1602 (2012). https://doi.org/10.1007/s00268-012-1533-0

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  • DOI: https://doi.org/10.1007/s00268-012-1533-0

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