Role of Pulmonary Metastasectomy of Hepatocellular Carcinoma after Liver Transplantation

Abstract

Purpose: Liver transplantation (LT) has been advocated as a good management option for patients with hepatocellular carcinoma (HCC). The rate of HCC recurrence after LT is about 20%. Although the median survival time of patients with HCC recurrence is 7∼9 months, the role of surgical treatment for metastatic tumors has been reported on. In this study, we evaluated the role of metastasectomy for treating patients with pulmonary metastasis from HCC after LT. Methods: We retrospectively analyzed 10 patients with pulmonary metastasis after LT and who were treated between April 2005 and October 2007. The underlying liver disease was cirrhosis caused by chronic viral hepatitis. The surveillance protocol for HCC recurrence was as follows: assessing the serum alpha-fetoprotein level every 1 month, chest and abdomen-pelvic computed tomography every 3 months and a bone scan every 1 year or when bone metastasis was suspected. The patients with less than 3 metastatic lesions were recommended to undergo metastasectomy (Group S, n=6) and the patients with more 4 lesions were recommended nonsurgical management, including chemotherapy (Group N, n=4). Results: All the metastatic lesions were detected on the protocol chest CT scans. The median recurrence time was 7.4 months (0.8∼18.2) after LT; this was 11.0 (4.8∼18.2) months for Group S and 2.0 (0.8∼3.3) months for Group N. One patient had a single lesion and the others had multiple lesions on multilobes. The median survival times of Group S were 29.3 (18.5∼41.3) months after pulmonary metastasis and 40.3 (23.3∼48.0) months after transplantation; 5 patients had no recorded evidence of their disease status. The median survival time of Group N was 4.3 (4.0∼6.3) months after metastasis and 6.2 (5.3∼7.1) months after transplantation; all the patients have since died. Conclusion: The survival outcome seemed to be good for the patients who underwent pulmonary metastasectomy for HCC, if it was detected earlier and it was resectable (≤3 lesions). However, further study is required for validating the survival benefit of pulmonary metastasectomy.