Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Surg. Sep 27, 2026; 18(9): 121591
Published online Sep 27, 2026. doi: 10.4240/wjgs.121591
Published online Sep 27, 2026. doi: 10.4240/wjgs.121591
Pulmonary metastasectomy for recurrent hepatocellular carcinoma after liver transplantation: A therapeutic challenge
Alessandro Pardolesi, Michele Ferrari, Giovanni Leuzzi, Piergiorgio Solli, Department of Thoracic Surgery, Istituto Nazionale Tumori, Milan 20133, Lombardy, Italy
Edoardo Ceruti, Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Lombardy, Italy
Ugo Cioffi, Matilde De Simone, Department of Surgery, University of Milan, Milan 20122, Lombardy, Italy
Gerardo Cioffi, Department of Sciences and Technologies, UniSannio, Benevento 82100, Campania, Italy
Co-first authors: Alessandro Pardolesi and Michele Ferrari.
Author contributions: Pardolesi A and Ferrari M contributed equally to this manuscript as co-first authors; Pardolesi A, Ferrari M, Leuzzi G, Ceruti E, Cioffi U, De Simone M, Cioffi G, and Solli P contributed to research and revised the manuscript, read and accepted the final version.
AI contribution statement: No AI tools, including ChatGPT or similar technologies, were used in the preparation of this manuscript. All aspects of the work, including data generation, analysis, interpretation, and writing, were performed solely by the authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Michele Ferrari, MD, Department of Thoracic Surgery, Istituto Nazionale Tumori, Via G.Venezian 1, Milan 20133, Lombardy, Italy.
Received: March 31, 2026
Revised: May 12, 2026
Accepted: June 16, 2026
Published online: September 27, 2026
Processing time: 171 Days and 22.4 Hours
Revised: May 12, 2026
Accepted: June 16, 2026
Published online: September 27, 2026
Processing time: 171 Days and 22.4 Hours
Core Tip
Core Tip: Liver transplantation is a definitive treatment for hepatocellular carcinoma, yet recurrence occurs 8%-20% of patients, with the lung being the most common extra-hepatic site. Pulmonary metastasectomy offers meaningful survival benefit in carefully selected patients with resectable, lung-limited disease and favorable tumor biology. Patient selection should prioritize disease-free survival, alpha-fetoprotein levels, and oligometastatic pattern, rather than immunosuppression management alone. We emphasize the need for rigorous, biology-driven selection criteria and prospective studies to define the role of surgery within a multimodal approach to extra-hepatic hepatocellular carcinoma recurrence.