초록접수 현황
| 16F-204 | 구연 발표 |
Surgical Outcomes of Pulmonary Metastasectomy in HCC Patients According to Approach Method: Thoracoscopic Versus Open Approach.
Han Pil Lee, Byung Kwon Chong, Jin San Bok, Kang Hoon Lee, Kang Hoon Lee, Se Hoon Choi, Yong-Hee Kim, Dong Kwan Kim, Seung Il Park, Hyeong Ryul Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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.
Methods : 136 patients (112 men) underwent pulmonary metastasectomy for isolated PM of HCC from October 1998 to December 2009 at Seoul Asan Medical Center. 87 patients were operated by VATS (VATS group) and the other 49 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).
Results : There was no operative mortality and minor complication in 9 patients (6.6%) including prolonged air-leak. During 36 month-follow-up period, 82 patients (60.3%) experienced recurrence and 90 patients (66.2%) died of disease progression. Matching based on propensity scores produced 30 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 number of PM to be an independent prognostic factor for survival (p=0.008) and disease-free survival (0.004).
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. Number of PM was an independent prognostic factor.
Methods : 136 patients (112 men) underwent pulmonary metastasectomy for isolated PM of HCC from October 1998 to December 2009 at Seoul Asan Medical Center. 87 patients were operated by VATS (VATS group) and the other 49 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).
Results : There was no operative mortality and minor complication in 9 patients (6.6%) including prolonged air-leak. During 36 month-follow-up period, 82 patients (60.3%) experienced recurrence and 90 patients (66.2%) died of disease progression. Matching based on propensity scores produced 30 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 number of PM to be an independent prognostic factor for survival (p=0.008) and disease-free survival (0.004).
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. Number of PM was an independent prognostic factor.
책임저자: Hyeong Ryul Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
발표자: Han Pil Lee, E-mail : inis.lee@gmail.com