Should Metastasectomy Be Performed Before Other Treatments?

Main Category: Lung Cancer
Also Included In: GastroIntestinal / Gastroenterology;  Transplants / Organ Donations;  Cancer / Oncology
Article Date: 03 Nov 2008 - 1:00 PDT

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Primary HCC is a major cancer related to HBV viral infection in Asian countries, including Japan. Recently, the primary liver cancers are successfully treated by surgical resection including liver transplantation and non-surgical locoregional therapy. Although infrequently, extrahepatic spread to the lungs occurs. So-called lung metastasis from liver cancer is a dilemma, because it is often believed that diseases are very advanced and too late for adequate treatment. It is partly true that most of the patients with lung metastasis from liver cancer do not survive for more than 1 year. However, surgical resection has gained the benefit of better survival in a selected group. It is not well understood regarding when and how to undergo surgery for lung metastasis. Although small in numbers, successful results after collaborative treatments for lung metastasis from liver cancers were achieved.

A research article published on October 7, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Professor. Moon from Kangnam St. Mary Hospital, the Catholic University of Korea, consists of thoracic surgeons, liver physicians, and liver surgeons. For 8 years, the researchers studied 23 patients with liver cancer and concurrent or subsequent lung lesions, who underwent lung surgery with collaborative guidelines. After lung surgery, the treatment plans had to be changed according to pathology-matched basis. With true lung metastasis, 16 patients were observed (the longest one being more than 8 years), and were analyzed for survival and clinical prognostic factors.

The 1- and 5-year survival rates after the lung surgery were 56% and 26%, respectively, most of whom otherwise would die within one year without lung surgery. Although statistical power is weak due to small numbers, new prognostic factor was identified: patients who underwent liver transplantation and developed lung metastasis, survived longer after lung surgery. This message suggests that liver transplantation is the standard for treatment of liver cancer and guarantees longer survival, even in case of lung metastasis.

Looking into long-term survivors for more than one year, proper control or treatment for primary liver cancers should be prerequisite for long-term survival. Hepatic cancer recurrence or hepatic dysfunction is the major cause of deaths. Their team approach helped the patients with lung metastasis survive longer rather than waiting for death. Minimally invasive or thoracoscopic surgery is another reason why the patients and physicians adopted lung surgery. Another concern was brain metastasis, which was fatal and detected before being dying. The researchers strongly recommended MRI for subclinical brain metastasis, which can be adequately treated by surgery or radiation surgery.

As indicated by peer reviewer, this clinical research failed to identify the promising clinical prognostic factors increasing survival for the patients with liver cancer and lung metastasis, but it is needed to identify significant prognostic factors in collaboration with multi-institutions. More importantly, research on these factors may provide adequate treatment guidelines for patients and oncologic specialists. Last but not least, clinical research based on well-designed treatment plan can advocate the proper treatment modality.

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Reference:

Kwon JB, Park K, Kim YD, Seo JH, Moon SW, Cho DG, Kim YW, Kim DG, Yoon SK, Lim HW. Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: Analysis of prognostic factors. World J Gastroenterol 2008; 14(37): 5717-5722 http://www.wjgnet.com/1007-9327/14/5717.asp

Correspondence to: Seok-Whan Moon, MD, Department of Thoracic and Cardiovascular Surgery, the Catholic University of Korea, St. Paul Hospital, 620-56 Jeonnong-Dong, Dongdaemun-Ku, Seoul 130-709, Korea.

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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Source: Lin Tian
World Journal of Gastroenterology

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