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  • Title: Long-term survival after pulmonary metastatectomy of hepatocellular carcinoma; treatment outcome or natural history?
    Author: Gwak GY, Jung JO, Sung SW, Lee HS.
    Journal: Hepatogastroenterology; 2004; 51(59):1428-33. PubMed ID: 15362769.
    Abstract:
    BACKGROUND/AIMS: To evaluate the role of pulmonary metastatectomy in hepatocellular carcinoma. METHODOLOGY: Four hepatocellular carcinoma patients underwent pulmonary metastatectomy. Patients were considered candidates for pulmonary metastatectomy when they met the following criteria; 1) intrahepatic hepatocellular carcinoma was under control or anticipated to be under control in the near future; 2) the metastatic lesions appeared to be amenable to complete resection; 3) there was no metastasis at another site. RESULTS: The median duration of follow-up was 4.1 (range: 2.4 to 6.0) years. During this period, 1 patient died of pulmonary recurrence 29 months after metastatectomy. The remaining 3 were alive at the time of writing; one for 43 months after metastatectomy without recurrence; another for 72 months with intrahepatic recurrence; and the third for 54 months with extrahepatic recurrence. CONCLUSIONS: Long-term survival was achieved after pulmonary metastatectomy in highly selected hepatocellular carcinoma patients. However, "highly selected patients" might imply that such patients belong to a special subgroup composed of cases with an intrinsically slow growing tumor biology. Therefore, it is an issue of interest as to whether the long-term survival acquired by these cases results from the pulmonary metastatectomy, or whether it is a reflection of a fate dictated by intrinsic tumor biology.
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