Lung metastases from hepatocellular carcinoma: multidisciplinary approach-narrative review

Objective: To describe and discuss the different treatment approaches concerning the management of lung metastasis from hepatocellular carcinoma (HCC). Background: HCC is the sixth most commonly diagnosed cancer and the third leading cause of cancer related deaths worldwide. Lungs are the most common site of extrahepatic metastases from HCC. Opposite to local recurrence, extrahepatic metastasis has to be considered a terminal-stage cancer with poor prognosis. Methods: The authors review the most recently published works regarding the different treatment approaches for lung metastasis from HCC. Conclusions: In this article, the authors review the surgical management of lung metastasis from HCC, with a particular focus on the outcomes and prognostic factors associated with long term survival after resection. Pulmonary metastasectomy seems to be the most effective treatment with most of the published experiences reporting a 5-year survival rate ranging from 17% to 46%. Resection of lung nodules from HCC in well-selected patients (tolerable risk; feasibility of a complete resection; sufficient expected pulmonary reserve after surgery; primary tumor under control) has the potential of improving long-term survival. Main areas of controversy regard the selection of surgical candidates and the operative approach. Chemotherapy offers only a limited benefit in metastatic disease while other local ablative techniques and hybrid therapies have been described as palliative techniques. Moreover, the new therapeutic approaches are described. A multidisciplinary setting is of paramount importance for choosing the most appropriate treatment within each case.