Resection Of Solitary Pulmonary Metastasis Research Articles

Resection of Solitary Lung Metastasis of Urinary Tract Transitional Cell Cancer Can Prolong Survival in Selected Patients

There are only a few small published studies on pulmonary metastasectomy for urinary tract transitional cell carcinoma (TCC). In this study, we examined the long-term outcome and the prognostic survival factors associated with pulmonary metastasectomy of urinary tract TCC, as based on our centre's 20-year experience. Between 2000 and 2020, curative pulmonary metastasectomy was performed in 18 patients (14 males and 4 females). Clinical, demographical and surgical data were retrospectively analysed. The disease-free interval between treatment of the primary tumour and pulmonary metastasectomy ranged from one to 48 months. Survival analysis was conducted with the Kaplan-Meier method and log-rank test. The 3- and 5-year survival rates were 84.7% and 52.9%, respectively. Resection of solitary metastases was a positive and independent factor for survival (p=0.04). Pulmonary metastasectomy of urinary tract TCC is associated with a favourable outcome and solitary metastasis is associated with long-term survival. Surgical resection of solitary pulmonary metastasis and repeated lung metastasectomy by pulmonary recurrence from a urinary tract TCC is feasible in selected patients.

食道胃接合部癌切除術後に発生した孤立性肺転移の1切除例

食道胃接合部癌切除術後に発生した孤立性肺転移の1切除例

Surgery for solitary pulmonary metastasis after curative gastrectomy for gastric cancer: Contribution to the long-term survival.

102 Background: Surgical resection is rarely indicated for pulmonary recurrence after curative gastrectomy for gastric cancer because most tumors recurred as multiple nodules or carcinomatous lymphangitis / pleuritis and prognosis is extremely poor. However, some investigators reported a sporadic case developing a solitary pulmonary metastasis which was surgically resected and resulted in a relatively favorable clinical outcome. The present study aimed to clarify contribution of surgery for solitary pulmonary recurrence to the long-term survival. Methods: We performed a systematic review of the literature by searching the words of “stomach”, “neoplasms”, “lung”, and “metastasis” in the Pubmed and Japanese ICHUSHI database, and analyzed the cases reporting on resection of solitary pulmonary metastasis after curative gastrectomy for gastric cancer together with our cases treated at our hospital. Overall survival was estimated by Kaplan-Meier method. Results: A total of 45 patients, 42 from a systematic review and 3 from our cases, were examined. Median age (range) was 67 years (31–84 years). Primary gastric cancer had the following characteristics; histologically differentiated type in 30 patients, undifferentiated type in 2, and unknown in 13 patients and tumor depth of T1 in 3, T2 in 6, T3 in 13, T4 in 9, and unknown in 6. Surgery for the primary gastric cancer was total gastrectomy in 30 patients and distal one in 15. The median (range) disease-free survival (DFS) between initial gastric resection and the detection of pulmonary metastasis was 28.0 months (5-128 months). Surgery for pulmonary tumor was lobectomies in 20 patients, segmentectomies in 3, wedge resections in 18, and unknown in 4. Only 4 patients received adjuvant chemotherapy after pulmonary resection. The median (range) follow-up period after pulmonary surgery was 20 months (3-98 months). The overall survival after pulmonary resection was 86% at 1-year, 62% at 3-year, and 56% at 5-year with the median (range) survival time of 67 months (3-98 months). Conclusions: Surgery for solitary pulmonary recurrence could contribute to the long-term survival.

Ten cases of resected solitary pulmonary metastases arising from gastric cancer.

Because carcinomatous lymphangitis and carcinomatous pleuritis are the usual forms of metastasis associated with gastric cancer, resection of solitary pulmonary metastases arising from gastric cancer is rarely performed. To clarify the characteristics of pulmonary metastases from gastric cancer, we investigated patients who underwent resection of metastatic solitary lung tumors arising from gastric cancer. Between October 2003 and October 2012, 10 patients underwent pulmonary metastasectomy for metastatic gastric cancer at our institution. We retrospectively evaluated features of the primary gastric cancer and the clinicopathological features of the pulmonary metastases in these cases. 70% of the patients had stage II disease. Lymphatic invasion was observed in all cases of primary gastric cancer. The method of pulmonary resection was partial resection in 5 cases, segmentectomy in 1, and lobectomy in 4. On histopathological examination, immunohistochemical staining was negative for thyroid transcription factor-1 and napsin A in all cases. Patients who underwent resection of pulmonary metastases arising from gastric cancer had a good prognosis: the 4-year survival rate was 75%. Carefully chosen patients have a good opportunity to obtain benefits from resection of pulmonary metastases arising from gastric cancer.

A Case of Long-term Survival after Surgical Resection of Solitary Pulmonary Metastasis from Gastric Cancer

We describe a 60-year-old male patient who survived for a long period after pulmonary metastasectomy for gastric cancer. The patient initially underwent distal gastrectomy for gastric cancer. Seventeen months after the gastrectomy, surgical resection of solitary pulmonary metastasis was performed and following resection, the patient has survived without relapse for more than 5 years. Carefully selected patients have a good chance of benefiting from pulmonary metastasectomy for gastric cancer.

Metastatic Tumor Doubling Time Is an Independent Predictor of Intrapulmonary Recurrence after Pulmonary Resection of Solitary Pulmonary Metastasis from Colorectal Cancer

Background: Several investigators have previously reported the prognostic factors affecting survival after a surgical resection of pulmonary metastasis from colorectal cancer (CRC). However, there have so far been no reports describing prognostic factors related to the tumor doubling time (TDT) of pulmonary metastasis. Methods: 65 patients with solitary pulmonary metastasis from CRC were retrospectively reviewed and the prognostic factors after pulmonary resection including TDT were analyzed. Results: The 5-year intrapulmonary recurrence-free survival rates after pulmonary resection was 59.9%. The TDT of pulmonary metastasis (<100 vs. 100 days or higher) was only a significant prognostic factor in intrapulmonary recurrence after the pulmonary resection (p = 0.0006). The 5-year overall survival rate after the pulmonary resection was 64.2%. Preoperative serum carcinoembryonic antigen (CEA) level (<5 vs. 5 ng/ml or higher) was the only significant prognostic factor in overall survival after the pulmonary resection (p = 0.0049). The overall survival of patients whose TDT was 100 days or higher tended to be better than that of patients whose TDT was <100 (p = 0.0631). Conclusions: The TDT of solitary pulmonary metastasis is a significant prognostic factor after surgery for solitary pulmonary metastasis from CRC.

胃癌術後の孤立性肺転移切除例の検討

目的．胃癌術後の胸部転移は，癌性リンパ管症や癌性胸膜炎で発症することが多く予後不良である．孤立性肺転移は比較的まれであるがその臨床像は知られていない．今回，当院で胃癌切除術を施行された症例を対象に，胃癌の孤立性肺転移切除術の意義を検討した．対象と方法．対象は1986年7月から2006年6月までに当院で行われた胃癌手術3219例中，術後の孤立性肺転移7例である．それぞれの臨床パラメーター，予後について検討した．結果．性別は男性4例，女性3例．胃癌の肉眼分類は7例中5例が2型病変．病理病期はIBが4例あった．胃癌術式は胃全摘術3例，幽門側胃切除術2例，残胃全摘術2例．肺転移出現時平均年齢70.1±10.2（57～84）歳．胃癌手術から肺転移出現までの期間は35±22（0～60）ヵ月．術前より肺転移が疑われた2例では区域切除が施行されているが，原発性肺癌と診断された5例中4例においては葉切除術が施行されていた．肺転移切除後の5年生存率は42.9％であった．結論．胃癌術後の孤立性肺転移は，術前より転移であることを診断するのは困難である．しかし，癌性リンパ管症や癌性胸膜炎や胃癌多発肺転移と比較して予後良好なため，胃癌術後に孤立性肺病変を認めた場合，積極的に診断と治療のための肺切除が望まれる．

Long term survival of thoracoscopic metastasectomy vs metastasectomy by thoracotomy in patients with a solitary pulmonary lesion

Aims: The aim of this study was to compare long term survival after resection of solitary pulmonary metastasis on CT scan performed by either thoracoscopy or through a standard thoracotomy.Methods:Patients with a solitary, CT scan confirmed, peripherally located lesion suspected for metastasis, less than 3cm in diameter were included. End points were: postoperative complication rate, disease free and overall survival and location of recurrence in the lung.Results: Thirty-five patients who underwent a thoracoscopic metastasectomy with (n=19) or without (n=16) confirmatory thoracotomy were included in this study. Patients experienced more complications following a thoracotomy (n=5) compared to those who had a thoracoscopy (n=0) (P=0.049). Two patients appeared to have further disease at thoracotomy besides the CT scan identified lesion, and some at thoracoscopy. At definitive histology, seven lesions were benign and eight appeared to be a second primary. Analysis of 20 patients with histological confirmed metastasis demonstrated a 2-year disease free and overall survival rate of 50% and 67% respectively following thoracoscopic metastasectomy (n=8) compared to 42% and 70% respectively following confirmatory thoracotomy (n=12). Recurrence occurred in three of the patients after thoracoscopic metastasectomy and in five patients after thoracotomy.Conclusion: Our results suggest that thoracoscopic resection of solitary peripherally located metastasis is a safe and potentially curative procedure with a long term outcome that is comparable with that after resection by thoracotomy.

Resection of Pulmonary Metastases - Results, Prognostic Factors, Reappraisal of Selection Criteria

Results of resection of solitary pulmonary metastases are good. In 107 patients treated in Amsterdam with a minimal follow-up of 2 years the actuarial 5-year survival rate is 46% and the 10-year survival 32%. Widening of selection criteria seems warranted. The prognostic factors are number and size of the metastases and tumor doubling time. The time interval between treatment of the primary tumor and the metastasectomy did not influence prognosis. The primary/secondary interval should not be used as a selection criterium.

Correlation of cell cycle analysis with Duke's staging in colon cancer patients

The biologic potential of a tumor for growth and metastasis is relatively inaccurately mirrored by the present staging system in colon cancers [29]. Except for Stage IV disease, traditional morphologic criteria approaches only 50-75% accuracy for predicting recurrent disease. Reliable staging, however, has become more critical in the light of the current thrust in adjuvant therapy research. First, the patients receive toxic and expensive therapy. Second, and of even greater importance, a central tenet of adjuvant therapy research is that treatment and control groups under study are comparable. Inadequate staging not only undermines analysis, especially when small improvements of lo-20% may be expected, but also demands very large study groups to offset this defect. A significant amount of research has attempted to quantitate the metastatic potential of a tumor. In the animal model some factors such as cell adhesiveness, tumor angiogenesis, detachability, thromboplasticity, and shedding of membrane antigen have been associated with an increased propensity of a tumor to spread [23]. In the clinical forum, analysis of factors such as tumor grade [4, 71, vascular invasion [7], host immune status [ 1, 8, 91 have not been established as having a clear-cut prognostic value. Hopefully prospective studies, objective criteria, and more sophisticated statistical analysis [6] may yield less disappointing results in the future. In this respect, accumulating evidence indicates that the analysis of tumor kinetics will be a major determinant of the metastatic potential of a tumor. It is well established that kinetic data of tumor doubling time and labeling index (LI) is associated with length of survival [ 11, 18, 21, 271, but the effect of tumor doubling time on ultimate survival was reported by Joseph et al. [12, 161. In his report, patients with resection of solitary pulmonary metastasis with doubling times less than 40 days subsequently died of metastasis whereas 60% of the patients with tumor doubling time over 40 days were cured. Other measures of tumor proliferative activity, i.e, mitotic index in sarcomas 1281 and labeling index in breast cancer patients 1151 have recently been implicated as important prognostic determinants, and in the former instance has been incorporated into the A.J.C. stating system [20] as a factor influencing tumor grading. Finally, the development of flow cytometry [24] has now made the rapid and objective analysis of cell cycle kinetics an exciting clinical reality. In this study, the predictive potential of cell cycle analysis by flow cytometry was examined by comparing the proliferative activity of colorectal adenocarcinoma with Duke’s staging and modified Broder’s grading.

SOLITARY OR "COIN" LESIONS OF THE LUNG. ANALYSIS OF 2,258 RECORDED CASES.

Of 2,258 solitary pulmonary nodules described in 22 reports, 37.8 per cent were malignant. An even larger proportion of these lesions are infectious granulomas. In differential diagnosis, size is important but not critical. Calcification is an important radiologic feature indicating benignancy. Excisional biopsy is usually necessary for exact diagnosis. For benign or metastatic lesions, simple excision is adequate; for primary malignancies presenting as solitary nodules, lobectomy is preferable to pneumonectomy. A 30 per cent five year survival can be expected following resection of solitary pulmonary metastases.

Adenocarcinoma of the Kidney: A 10-Year Apparent Cure following the Resection of Solitary Pulmonary Metastasis

Adenocarcinoma of the Kidney: A 10-Year Apparent Cure following the Resection of Solitary Pulmonary Metastasis

Resection of multiple metastatic pulmonary lesions of osteogenic sarcoma.

Despite the ever-widening horizons of surgery, resection of metastatic malignant lesions, especially multiple metastatic malignant lesions, has not reached a point of full acceptance by the medical profession. The idea is not a new one, for as long ago as 1853 Kroenlein 1 reported a case. Since that time other reports have appeared in the literature, and, as one might expect, the number of reports has increased in recent years. Nevertheless, experience with operation for metastatic malignancy remains both limited and incomplete, especially as to long-term follow-up studies. At the present time surgical resection of solitary pulmonary metastases is on rather firm ground. Alexander and Haight 2 collected 24 cases from the literature in 1947. Experience at the Mayo Clinic was reported by Hood and associates 3 in 1955; they included a total of 43 cases. Of interest is the fact that their first resection took place in 1941, and