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

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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.
Author(s)
김동관김용희김형렬문덕환박승일윤재광이근동이한필정희석최세훈
Issued Date
2021
Type
Article
Keyword
Hepatocellular carcinomaPMMetastasectomyVideo-assisted thoracoscopic surgery (VATS)
DOI
10.1186/s12957-021-02138-0
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8756
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_doaj_primary_oai_doaj_org_article_ccd964f128ce43a28542bb341ddab366&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Surgical%20outcomes%20of%20pulmonary%20metastasectomy%20in%20hepatocellular%20carcinoma%20patients%20according%20to%20approach%20method:%20thoracoscopic%20versus%20open%20approach&amp;offset=0&amp;pcAvailability=true
Publisher
World Journal of Surgical Oncology
Location
미국
Language
영어
ISSN
1477-7819
Citation Volume
19
Citation Number
1
Citation Start Page
33
Citation End Page
33
Appears in Collections:
Medicine > Medicine
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