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Surgical outcomes of pulmonary metastasectomy in hepatocellular carcinoma patients according to approach method: thoracoscopic versus open approach

Authors
 Han Pil Lee  ;  Jae Kwang Yun  ;  Hee Suk Jung  ;  Duk Hwan Moon  ;  Geun Dong Lee  ;  Sehoon Choi  ;  Yong-Hee Kim  ;  Dong Kwan Kim  ;  Seung Il Park  ;  Hyeong Ryul Kim 
Citation
 WORLD JOURNAL OF SURGICAL ONCOLOGY, Vol.19(1) : 33, 2021-12 
Journal Title
WORLD JOURNAL OF SURGICAL ONCOLOGY
Issue Date
2021-12
MeSH
Carcinoma, Hepatocellular* / surgery ; Colorectal Neoplasms* ; Humans ; Liver Neoplasms* / surgery ; Lung Neoplasms* / surgery ; Male ; Metastasectomy* ; Neoplasm Recurrence, Local / surgery ; Pneumonectomy ; Prognosis ; Retrospective Studies ; Seoul ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Treatment Outcome
Keywords
Hepatocellular carcinoma ; Metastasectomy ; PM ; Video-assisted thoracoscopic surgery (VATS)
Abstract
Background: The role of surgical intervention as a treatment for pulmonary metastasis (PM) from hepatocellular carcinoma (HCC) has not been established. In this study, we investigated the clinical outcomes of pulmonary metastasectomy. Using propensity score matching (PSM) analysis, we compared the results according to the surgical approach: video-assisted thoracic surgery (VATS) versus the open method.

Methods: A total of 134 patients (115 men) underwent pulmonary metastasectomy for isolated PM of HCC between January 1998 and December 2010 at Seoul Asan Medical Center. Of these, 84 underwent VATS (VATS group) and 50 underwent thoracotomy or sternotomy (open group). PSM analysis between the groups was used to match them based on the baseline characteristics of the patients.

Results: During the median follow-up period of 33.4 months (range, 1.8-112.0), 113 patients (84.3%) experienced recurrence, and 100 patients (74.6%) died of disease progression. There were no overall survival rate, disease-free survival rate, and pulmonary-specific disease-free survival rate differences between the VATS and the open groups (p = 0.521, 0.702, and 0.668, respectively). Multivariate analysis revealed local recurrence of HCC, history of liver cirrhosis, and preoperative alpha-fetoprotein level as independent prognostic factors for overall survival (hazard ratio, 1.729/2.495/2.632, 95% confidence interval 1.142-2.619/1.571-3.963/1.554-4.456; p = 0.010/< 0.001/< 0.001, respectively).

Conclusions: Metastasectomy can be considered a potential alternative for selected patients. VATS metastasectomy had outcomes comparable to those of open metastasectomy.
Files in This Item:
T202101094.pdf Download
DOI
10.1186/s12957-021-02138-0
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Moon, Duk Hwan(문덕환)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/186740
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