Pulmonary resection for non-small cell lung cancer in patients with hepatocellular carcinoma

This study was designed to determine the clinical characteristics and verify the results of surgical treatment for non-small cell lung cancer (NSCLC) in patients with hepatocellular carcinoma (HCC), from the results of retrospective analysis of the cases.

We retrospectively reviewed our database of 751 patients who underwent curative surgical intervention for NSCLC from January 1993 to December 2006 and found 11 patients with NSCLC with coexisting or previously treated HCC at a perioperative period of lung cancer surgery. Postoperative complications and long-term outcome were analyzed.

All cases had coexisting liver cirrhosis. The overall morbidity was 27.2% (n = 3). All complications were considered to be the result of liver cirrhosis-related conditions, such as liver failure (n = 2), postoperative bleeding from the thoracic tube (n = 2), and gastrointestinal bleeding (n = 1). There was no operative mortality. The 1-, 3-, and 5-year survival rates of patients with lung cancer were 88.9%, 74.1%, and 74.1%, respectively. The 1-, 3-, and 5-year survival rates for death from hepatic causes were 79.5%, 79.5%, and 39.8%, respectively. Overall survival rates were 70.7%, 58.9%, and 29.5%, respectively. Preoperative indicators of liver function, such as serum values of total bilirubin (P < 0.01), choline esterase (P < 0.05), prothrombin test (P < 0.01), and platelet count (P < 0.05), were significantly correlated with long-term survival, whereas local extensiveness and nodal stage of lung cancer were not.

We conclude that postoperative complications and factors that influence long-term survival are correlated with the severity of impaired liver function, whereas early and mid term death are the result of lung cancer. Standard operation is encouraged for NSCLC when the patient is expected to live more than 3 years with impaired liver function, even if coexisting with HCC.