Author of

• 20165

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  P1.16 - Surgery (ID 702)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 22822

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    P1.16-020 - Outcomes of Pulmonary Metastasectomy in Hepatocellular Carcinoma According to Approach Method-Thoracoscopic Versus Open Approach (ID 9872)

    09:30 - 09:30  |  Author(s): H.P. Lee
    • Abstract

    Background:
    Proper management for pulmonary metastasis (PM) after control of primary hepatocellular carcinoma (HCC) has not been established and chemoradiation therapy has been largely ineffective. We investigated clinical outcomes of pulmonary metastasectomy and risk factors for survival rates, and disease-free survival rates in HCC with PM. With propensity score matching analysis, we compared the results according to surgical approach: video-assisted thoracic surgery (VATS) versus open (thoracotomy or sternotomy) method.
    
    Method:
    136 patients (112 men) underwent pulmonary metastasectomy for isolated PM of HCC from October 1998 to December 2010 at Seoul Asan Medical Center. 86 patients were operated by VATS (VATS group) and the other 50 patients were operated by thoracotomy or sternotomy (Open group). Propensity score analysis between VATS group and Open group was utilized and matched the groups by age, sex, level of preoperative AFP, treatment method for primary HCC, and PM characteristics (number, size, location, time to interval and range of resection).
    
    Result:
    There was no operative mortality and minor complication in 10 patients (7.3%) including prolonged air-leak. During 36 month-follow-up period, 112 patients (82.4%) experienced recurrence and 102 patients (75%) died of disease progression. Matching based on propensity scores produced 50 patients in each group for analysis of survival and disease-free survival. There were no survival and disease-free survival differences between matching VATS group and Open group. Multivariate analysis revealed hepatic recurrence, preoperative level of alpha-fetoprotein, liver cirrhosis to be an independent prognostic factor for survival and disease-free survival.
    
    Conclusion:
    Pulmonary metastasectomy may prolong survival in selected patients with HCC. VATS metastasectomy provided comparable outcomes to open metastasectomy in regard to survival rate and disease-free survival rate. Liver recurrence, preoperative level of alpha-fetoprotein, liver cirrhosis were independent prognostic factors for survival and disease-free survival.