Pulmonary metastasectomy for recurrent hepatocellular carcinoma after liver transplantation: A therapeutic challenge

Le résumé fourni par la source

Recurrence of hepatocellular carcinoma remains the leading cause of mortality after liver transplantation (LT), with the lungs representing the most frequent extrahepatic site. This review evaluates the role of pulmonary metastasectomy in carefully selected LT recipients, with a focus on patient selection criteria, surgical indications, and multimodal treatment strategies. A scoping review was conducted using the PubMed database. The search incorporated the following terms: “hepatocellular carcinoma”, “pulmonary metastasectomy”, “liver transplantation”, “recurrence”, and “tumor biology”. Studies published in English from 2005 onward were included if they specifically addressed pulmonary metastases in post-LT patients. Non-transplant populations and non-English articles were excluded. Studies were selected based on their relevance to the topic. Evidence, primarily from small retrospective series, supports pulmonary metastasectomy in highly selected patients with lung-limited disease. Favorable prognostic factors include a disease-free interval exceeding 12 months, low or normal alpha-fetoprotein levels, and limited metastatic burden. Reported 5-year overall survival rates range from 33% to 43%, indicating a potential survival benefit in appropriately selected cases. Pulmonary metastasectomy offers a valuable therapeutic option for LT recipients with resectable, lung-confined recurrence and favorable tumor biology. For unresectable or disseminated disease, alternative strategies including locoregional and systemic therapy should be pursued within a multidisciplinary framework.

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