Good long-term survival is achievable for patients with resectable recurrent lung metastases. Multiple metastases and atypical resection at first metastasectomy were associated with recurrent disease. Neither lymph node metastases nor liver metastases were significantly associated with recurrence. Lower grading of the primary tumor was the only independent prognosticator for survival. All in all, the factors that can be influenced by the surgeon are patient selection and R0 resection.
Primary tumors of the diaphragm are rare. Secondary tumors of the diaphragm with origin in thoracic or abdominal cavity occur more frequent than primary tumors. In most cases, the therapy of choice includes a complete surgical resection of these tumors. This article reports on different types of tumors of the diaphragm, as well as surgical and reconstructive techniques.
Anatomic resections with bronchial and/or vascular resections and reconstruction, so called sleeve resections were originally performed in patients with impaired cardio-pulmonary reserves. Nowadays, sleeve resections are established surgical procedures of first choice for tracheobronchial pathologies, whenever anatomically and oncologically feasible. Experienced thoracic surgeons have a broad surgical armentarium to avoid a pneumonectomy and the morbidity and mortality associated with it. Sleeve resections are associated with better outcomes in all aspects. Thus, sleeve resection is not an alternative for pneumonectomy and vice versa. In this review article we set out to provide a contemporary overview on this topic.
Multimodality treatment including surgery was safe and led to considerable survival. R0 resection was the only factor extending survival. It could be achieved in most patients and was associated with a low risk of locoregional relapse. Prospective randomized controlled studies are needed to define best practice in stage IA-IIIB SCLC.
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