Surgical Treatment Of Pulmonary Metastases Research Articles

Analysis of surgical treatment of pulmonary metastases in nasopharyngeal carcinoma-A report of 23 cases

Analysis of surgical treatment of pulmonary metastases in nasopharyngeal carcinoma-A report of 23 cases

Pulmonary Metastasectomy for Melanoma

After primary tumor treatment, 30% of patients with malignant melanoma develop metastatic disease, usually associated with a poor prognosis. Effective chemotherapeutic regimens for metastatic melanoma are not currently available. Surgical treatment of pulmonary metastases remains controversial because of the dismal survival rates reported in several studies. However, for patients with good performance status, long disease-free interval, limited metastatic disease, and less aggressive tumor biology, it remains an option. The authors have analyzed their experience in 26 patients operated on between 2000 and 2008 alongside a review of the large series in the literature.

140P THE ROLE OF THORACIC SURGERY IN TREATMENT OF PULMONARY METASTASIS

Background The problem of surgical treatment of pulmonary metastasis is still alive, it is accepted in the world as a curative way of treatment of pulmonary metastasis. But the problem lies in the Czech Republic that only a few oncologists accept it as one of the most effective ways of treatment. Prognostic factors for pulmonary metastasectomies are complete resection, disease free interval, the amount and size of the metastasis, tumor double time, histology of the primary tumor and biologic aggressiveness of the tumor. Methods The effect of the surgery is based on exact diagnostic investigation (X-ray, HRCT, PET-CT) and on the proper selection of patients based on the contol of the primary tumor, no metastasis in other localizations, the possibility of complete resection, good cardiopulmonal condition of the patient, no other better way of treatment and low-operative risk. As contraindications are mostly considered low pulmonary function, impossibility of complete resection and the presence of many tiny metastasis. According to the size, number and side is chosen the right access to the pulmonary cavity and the proper surgery is performed. The importance of mediastinal lymphadenectomy was not defined yet. The presence of positive lymphnodes is not a good prognostic factor for long-time survival rate. Results The authors will present the results of pulmonary metastasectomies in the last ten years on over 100 patients performed in our department. Most of the surgeries were performed by atypic resection with safety margin, also some lobectomies and enclueations. No pneumonectomy was performed. Mediastinal lymphadenectomy was performed at carcinomas. Conclusions Pulmonary metastasectomy can be when performed by a experienced surgeon and after an exact indication, a way of secure, effective and potentially curative treatment .

CLC006 ORAL Surgical treatment of pulmonary metastases from soft tissue sarcoma: analysis of prognostic factors

CLC006 ORAL Surgical treatment of pulmonary metastases from soft tissue sarcoma: analysis of prognostic factors

CLC051 POSTER Surgical treatment of pulmonary metastases of osteosarcoma

CLC051 POSTER Surgical treatment of pulmonary metastases of osteosarcoma

Thoracic surgery in children

Children rarely undergo thoracic surgery. When they do, the procedures fall into five main groups: oncologic indications, immune defects, malformations, infections and trauma. In addition to considerations associated with the underlying indication, the different proportions of the anatomical structures in children require special modifications in both diagnostics and surgical technique compared to corresponding procedures in adults. Of a total 2137 thoracic surgical procedures performed between 1992 and 2001, 49 were performed in children (n = 37; age: 3 months-15 years; median age: 8 years). Indications for surgery included underlying oncologic disease (n = 20), immunodeficiency (n = 5), thoracic or pulmonary malformation (n = 6) and trauma (n = 3). Patients' postoperative clinical course was analyzed retrospectively for all 49 procedures. Pre- and postoperative pulmonary function test results are available for 16 children. Data regarding quality of life were documented in 24 children. The following procedures were performed: 27 atypical resections, seven lobectomies, one pneumonectomy, three decortications, four mediastinotomies or mediastinoscopies and seven other procedures. Six procedures represented second or third procedures in the same patient. Two of six patients with immune defects died during the perioperative period. Eleven of 20 oncologic patients (55%) have remained free of recurrent disease. Quality of life, as assessed by the Karnowski index in 24 children, was at least 80%. Thoracic surgical procedures in children with underlying benign disease are associated with a good prognosis and high quality of life scores. Surgical treatment of pulmonary metastases is a feasible component of the overall oncologic therapy concept and can offer the only opportunity for curation for a selected group of patients. Because of high postoperative mortality, however, the indication for diagnostic thoracotomies in children with immunodeficiencies and poor general health should be weighed critically.

Surgical treatment for metastatic malignancies. Pulmonary metastasis: indications and outcomes

Surgical resection is an important modality in the treatment of pulmonary metastases from various solid tumors. The criteria for pulmonary metastasectomy are as follows: (1) the patient must be a good risk for surgical intervention; (2) the primary malignancy is controlled; (3) there is no other, extrapulmonary, metastasis; and (4) the pulmonary lesions are thought to be completely resectable. The appropriate selection of candidates according to these criteria leads to an overall 5-year survival after pulmonary metastasectomy of about 30%-40%. However, most of the reported results are retrospective analyses, and the significance of pulmonary metastasectomy seems to vary according to the primary malignancy. To clarify the significance of surgical treatment for pulmonary metastases, we need further analysis of various prognostic factors, with special reference to each primary malignancy, as well as a multiinstitutional study, and randomized prospective studies, if possible.

大腸癌肝転移切除例における肺転移巣切除の臨床的意義に関する検討

大腸癌の肝転移切除後の肺転移に対する外科的治療法の意義を確かめるため,1977年から2002年12月までの大腸癌肝転移巣の切除例89例のうち肺に重複転移をきたし切除しえた12例の臨床病理学的所見を検討した.原発巣と同時性の肝転移例は7例で,3例は肝肺ともに同時性であった.残る5例のうち3例は異時性に肝肺同時転移を認め,他の2例は異時性に肝転移をきたしたのち,さらに遅発性に肺転移を認めた.12例とも術後在院死はなく退院した.12例の最終手術後の5年生存率は40.0%,5年無再発生存率は12.5%であった.1例が12年間無再発生存中である.最終手術後1年以内に再発した9例の各転移巣の出現間隔の平均は7.1カ月で,1年以上無再発であった3例の平均37.0カ月に比較し,出現間隔が短かった(p<0.01).大腸癌の肝肺転移例においても肝または肺単独転移例と同等の術後成績を得ることができ,特に長い期間をおいて各転移巣が出現する場合には長期生存も期待できることから積極的に手術適応を考慮すべきと思われる.

Surgical treatment of pulmonary metastases from renal cancer

Based on a large single-center follow-up database, we evaluated the long-term results after curative resection of pulmonary metastases from renal cancer. During a 20-year period, 105 patients underwent a total of 150 resections with curative intention. Hospital mortality was 0.95%, 5- and 10-year survival rates were 40% and 33%, respectively. Significant prognostic relevance was shown for complete pulmonary resection, lymph node involvement upon primary resection as well as size of the resected lung metastasis. Our findings of low perioperative morbidity and mortality rates lead us to propose that in patients without additional metastases curative resection of pulmonary lesions should be considered. Moreover, recurrent pulmonary metastases should also be considered for surgical treatment since resection for cure significantly improves survival in these patients.

大腸癌肺転移に対する外科治療

大腸癌肺転移に対する外科治療

Surgical treatment of pulmonary metastases: experience with 40 patients

Aims: Combinations of surgery and chemotherapy have a favourable impact on survival in the treatment of disseminated neoplastic disease isolated to the lung. Sample and technical factors have made the reproduction of the published results difficult. Methods: In this study we report experience over 10 years. Results: From 1989 to 1999 40 patients underwent metastasectomy. Thirty received chemotherapy. The median survival is 51 months, similar to other published series. Conclusion: Survival benefit can be observed in small series of such cases.

肝細胞癌術後肺転移例に対し外科治療が奏効した３例

肝細胞癌術後肺転移例に対し外科治療が奏効した３例

Tratamiento quirúrgico de las metástasis pulmonares: estudio de supervivencia

To study the results of surgical treatment of pulmonary metastases in our department. We retrospectively studied 44 patients undergoing surgery between 1986 and 1999 for complete resection of pulmonary metastases. Primary tumors had been eradicated, no metastasis to other organs was evident, and functional respiratory capacity was adequate. The patients were assigned to different prognostic groups based on the criteria of the International Registry of Lung Metastases. Forty-eight operations were performed on the 44 patients (21 men and 23 women) whose mean age was 58 years (31-74 years). The most frequent type of primary tumor was epithelial (82%); other types in order of frequency were sarcoma (9%), thyroid gland (4.4%), germ cell (2.2%) and melanoma (2.2%). The mean disease-free interval was 37.7 months (0.168) and the median was 30 months. A single site of metastasis was seen in 66.7% of the cases whereas 33.3% had multiple metastases (17.9% of them bilateral). Posterolateral thoracotomy was the surgical approach in over half the cases (66.7%). We performed wedge resections in 86.6% and lobectomies in 11.1%. Perioperative mortality was 4.4%. Mean survival was 70 months, with 87% alive at one year and 29% at 10 years. For group I (resectable, no risk factors; n = 13) survival was 100% at one year and 75% at 10 years. For group II (resectable, one risk factor; n = 16) the actuarial survival was 78% at one year and 12% at 10 years. For group III (resectable, two risk factors; n = 8), survival was 87% at one year, 62% at three years, 15% at four years and 0% at five years (Log-rank chi 2 9.8 [df = 2)], p = 0.0097). Surgical resection of pulmonary metastasis is a treatment and diagnostic procedure associated with low mortality and good survival. Prognostic grouping that takes into account number of metastases, disease-free interval and resectability correlates significantly with expected survival regardless of histological typing of the primary tumor.

Die chirurgische Behandlung von Lungenmetastasen extrapulmonaler Primärtumoren - eine retrospektive Analyse von 1982-1995

Background: Because of the controversial discussion, even with conservative specialities, the aim of the study was to show that the surgical treatment of pulmonary metastasis is an adequate therapy with low morbidity and mortality, good survival rates and an increasing quality of life.¶Methods: From January 1982 until May 1992 we retrospectively reviewed all patients with pulmonary metastasis and completed follow-up until May 1995. Beside peri- and postoperative data we made a multivariant analysis to find the relevant prognostic factors and to define the survival rates.¶Results: Over a period of 10 years 73 patients underwent an operation for pulmonary metastasis. Follow-up was completed in 48 patients (21 female, 27 male). Median age was 47.4 years. Most primary tumors were adenocarcinoma of the colon (n=9), renal-cell-carcinoma (n=9), melanoma (n=6), osteosarcoma (n=5), and uterus carcinoma (n=5). There were 61 operations nessecary in the 48 patients. The procedure was a lateral thoracotomy in 93.4% and a median sternotomy in 6.6%. The surgical technique was a wedge resection in 67.2% and an anatomic resection in 31.2%. 62.5% of the patients had solitary metastasis, 22.9% had 2–4, and 14.6% had multiple metastasis. The median disease-free interval (DFI) of all patients was 24 months. 30 day-mortality was 1.1%; morbidity was 3.3%. Mean hospitalization time was 11 days. The 3-year-survival of all patients was 37.5%. The following relevant prognostic factors were found: site of primary tumor (p>0.05), number of metastasis (p 2 years (45.5%). There were no differences in spite of the surgical technique.¶Conclusions: Because of low mortality and morbidity, as well as good long-term results and without satisfying conservative treatments, the surgical treatment should be favored in pulmonary metastasis. It is a safe and sure therapy for the treatment of pulmonary metastasis.

Surgical Treatment of Pulmonary Metastases

Pulmonary metastatectomy has been widely adopted for the treatment of malignancies spread to the lungs. This article reviews the historical development of the procedure, pertinent anatomical background information, means of postoperative evaluation, and the conduct and results of surgery.

大腸癌肺転移切除症例の検討

大腸癌原発の肺転移切除症例の27例を対象として術後の治療成績を検討した.性別は男性17例女性10例, 年齢は41歳から90歳 (平均年齢63.5歳) であった.現在までに10例が生存中で, 17例が死亡した.肺切除後の50%生存期間は33.9ヵ月, 累積5年生存率は31.0%であった.予後因子別の遠隔成績では肺外への転移の既往の有無で累積生存率に関して有意差を認めたが, 肺転移の数, 最大径, 血清CEA値などでは有意差を認めなかった.

Surgical treatment for pulmonary metastases of squamous cell carcinoma of the head and neck

Purpose: As locoregional control of head and neck cancer has improved, distant metastases have become increasingly common problems. Patients and Methods: To determine the role of surgical treatment, we reviewed 32 patients with squamous cell carcinoma (SCC) of the head and neck who underwent thoracotomy for pulmonary metastases. Results: The overall 5-year survival rate was 32%. The 5-year survival rate of the patients with SCC of the oral cavity was significantly poorer than that of the patients with other primary site (15.4% v 45.2%; P = .01). In the patients with single nodule, extent of the tumor was a significant prognostic factor ( P = .007). Mediastinal lymph node involvement ( P = .004) and pleural invasion ( P = .04) also correlated with survival. Conclusion: TNM classification of the primary tumor did not have an impact on survival in this study. Further studies of a large series should be performed to determine the indications and modalities of the surgical treatment for pulmonary metastases of the SCC of head and neck.

The Surgical Treatment of Pulmonary Metastases

The surgical management of pulmonary metastases remains controversial, as no randomized trials have compared surgical excision with nonoperative treatment (to our knowledge). A Medline-generated review of the literature was undertaken to determine the factors influencing survival following metastasectomy in published trials. In the absence of randomized comparative trials, data must remain inferential and circumstantial. However, the literature does support the anecdotal observation that patients with metastatic disease can achieve long-term survival following surgical excision, irrespective of the source of the primary neoplasm, if there is no demonstrable extrathoracic disease and complete excision of the pulmonary disease is possible. Other factors noted as influencing survival appear to be anecdotal and variable from report to report. Pulmonary metastasectomy should be considered in patients with sufficient pulmonary reserve when the lung is the only site of metastatic disease and the lesions can be totally excised. An algorithm is proposed for a logical approach to the problem.

Surgical Treatment for Pulmonary Metastases

Surgical Treatment for Pulmonary Metastases

Pulmonary resection for metastatic colorectal cancer: Experiences with 159 patients

We reviewed the clinical courses of 159 patients between February 1967 and May 1995 for the purpose of examining the survival of patients who had pulmonary resection for metastatic colorectal cancer. The cumulative survivals at 5 years and 10 years were 40.5% and 27.7%, respectively. Fifteen patients (10%) were alive more than 10 years after the thoracotomy without any evidence of recurrence. The cumulative survival at 5 years for 39 patients who had hepatic metastases before thoracotomy was 33%. There was a statistically significant difference in survival between patients with extrapulmonary metastases and those with only intrapulmonary metastases before thoracotomy. The number of pulmonary metastases and the presence of hilar or mediastinal lymph node metastases affected postthoracotomy survival. There was no significant difference in survival on the basis of sex, age, location of the primary cancer, size of the pulmonary tumors, mode of operation, or disease-free interval. Surgical treatment for pulmonary metastases from colorectal cancer in selected patients, even those who had hepatic metastases before thoracotomy, might improve prognosis. (J T HORAC C ARDIOVASC S URG 1996;112:867-74)