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Z Gastroenterol 2016; 54(01): 31-39
DOI: 10.1055/s-0041-104025
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Pulmonary metastasectomy for metastasized hepatocellular carcinoma after liver resection and liver transplantation: a single center experience

Pulmonale Metastasektomie bei metastasiertem hepatozellulärem Karzinom nach Leberresektion und Lebertransplantation: Eine Single Center-Studie
H. M. Hau
1   Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany
,
M. Schmelzle
1   Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany
2   Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Germany
,
C. Benzing
1   Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany
,
R. Ascherl
1   Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany
,
H. M. Tautenhahn
1   Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany
,
G. Gäbelein
1   Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany
,
U. Eichfeld
1   Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany
,
M. Bartels
1   Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital Leipzig, Germany
› Author Affiliations
Further Information

Publication History

02 April 2015

20 July 2015

Publication Date:
30 November 2015 (online)

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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.

Conclusion: 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.

Zusammenfassung

Hintergrund: Die Rolle chirurgischer Therapieoptionen beim metastasierten hepatozellulären Karzinom (HCC) bleibt ungewiss. Wir berichten unsere Single Center-Ergebnisse für die pulmonale Metastasektomie (PM) im Falle von metachronen HCC-Metastasen der Lunge nach stattgehabter kurativer Leberresektion (LR) bzw. Lebertransplantation (LT).

Material und Methoden: Von 270 Patienten mit der Diagnose eines HCC, die mit LR oder LT am Universitätsklinikum Leipzig zwischen 1996 und 2014 behandelt wurden, wurde eine PM bei 10 Patienten beim Auftreten metachroner pulmonaler HCC-Metastasen durchgeführt. Die demografischen und klinisch-pathologischen Daten sowie das Outcome nach primärer und sekundärer Tumorbehandlung wurden bei diesen Patienten analysiert.

Ergebnisse: Nach stattgehabter LR/LT bzw. Metastasektomie lag das mittlere Gesamtüberleben bei 4,58 ± 0,84 bzw. 2,4 ± 0,69 Jahren. Die postoperative Morbidität nach primärer und sekundärer Tumorbehandlung lag bei 30 bzw. 20 %. Die perioperative 30-Tages-Mortalität betrug 0 %. Die univariate Analyse zeigt, dass das Tumorgrading (p < 0,05) und ein krankheitsfreies Überleben von > 1 Jahr (p = 0,02) signifikante prognostische Parameter in unserem Patientenkollektiv darstellen.

Zusammenfassung: PM ist ein sicheres Verfahren mit akzeptabler Morbidität sogar bei immunsupprimierten Patienten nach LT. Es sind weitere Studien notwendig, um zu evaluieren, ob PM das Langzeitüberleben bei ausgewählten Patienten mit resektablen Metastasen verbessern und somit eine alternative oder additive therapeutische Option zur Sorafenib-Therapie darstellen kann.

Schlüsselwörter

pulmonaler Metastasen - Metastasektomie - hepatozelluläres Karzinom

Key words

pulmonary metastases - metastasectomy - hepatocellular carcinoma
 

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