Abstract
Purpose. To assess the effectiveness of various techniques of surgery of pulmonary metastases based on the outcomes of surgery interventions, frequency of postoperative complications and overall survival of patients.Patients and methods. Ninety-seven patients with suspected lung metastases of known primary malignancies (47 men and 50 women, mean age of 46,5 years) were retrospectively included in two study groups between 1 January 2004 and 1 January 2016 and underwent pulmonary surgery with the Nd: YAG laser of the 1318 nm wavelength (Group A, n = 44) or with the electrocautery (Group B, n = 53).Results. A total of 151 operations were performed: 75 in Group A, 76 in Group B. The mean number of resected pulmonary lesions was 8,2 (95% CI: 5,2–11,1) in group A and 4,9 (95% CI: 3,7–6,0, p = 0,047) in group B. Additionally 87 lesions were evaporated due to small sizes (1–2 mm) in Group A. The mean time of surgery was 146 minutes in Group A and 113 minutes in Group B (p < 0,01).Post-surgery complications were diagnosed after 9 and 19 of interventions in Groups A and B, respectively. The most common complications were pneumonia, pneumothorax and subcutaneous emphysema. The number of Grade III complications according to Clavien-Dindo classification was 2 and3 inGroups A and B, respectively. The survival rates were computed for all patients: the one-year, three-year and five-year survival rates were 83,7%, 49,7% and 36,7%, respectively.Conclusion. The Nd:YAG laser with wavelength of 1318 nm allow extensive parenchymal resections without an increase in post-surgery complications and may have advantages in pulmonary metastasectomy, especially in patients with multiple pulmonary lesions.
Highlights
To assess the effectiveness of various techniques of surgery of pulmonary metastases based on the outcomes of surgery interventions, frequency of postoperative complications and overall survival of patients
The survival rates were computed for all patients: the one-year, three-year and five-year survival rates were 83,7%, 49,7% and 36,7%, respectively
Finding the evidence for pulmonary metastasectomy in colorectal cancer: the PulMicc trial
Summary
РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ ND:YAG-ЛАЗЕРА И ЭЛЕКТРОКОАГУЛЯТОРА В ХИРУРГИИ ЛЕГОЧНЫХ МЕТАСТАЗОВ. Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской Федерации, 249036, Российская Федерация, Калужская область, г. Оценить эффективность использования различных способов хирургического вмешательства при метастатическом поражении легких по исходам операций, частоте послеоперационных осложнений и выживаемости больных. Больные были разделены на группы в зависимости от метода воздействия на легочную паренхиму: в группу А включены пациенты (n = 44), у которых применяли Nd:YAG (неодимовый иттрий-алюминий-гранат) лазер с длиной волны 1318 нм на легочной паренхиме, в группе В (n = 53) резекцию легкого осуществляли электрокоагулятором. При использовании лазера число удаленных очагов в среднем составило 8,14 (95% доверительный интервал (ДИ): 5,2–11,1), также 87 очагов было интраоперационно выпарено при их малых размерах (1–2 мм). Использование Nd:YAG-лазера с длиной волны 1318 нм при метастазэктомии легких является безопасным и эффективным методом, особенно у пациентов с множественным метастатическим поражением легочной паренхимы. Статья поступила 13.02.2018 г., принята к печати 30.05.2018 г
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