Ressecção cirúrgica de metástases pulmonares: estudo prospectivo em 182 pacientes

Younes, Riad Naim; Haddad, Fábio J.; Ferreira, Fábio Oliveira; Gross, Jefferson Luiz

doi:10.1590/s0104-42301998000300010

Cited by 9 publications

(22 citation statements)

References 26 publications

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“…We understand this finding to mean that the need for neoadjuvant and adjuvant treatment indicates disease in more advanced stages and weakness associated with sequential multimodal treatment. However, this finding is in disagreement with the results reported by Younes et al,( 8 ) who found a significant improvement in survival in the group of patients who underwent chemotherapy/radiotherapy, as well as with the finding of an absence of significant differences between these two groups in the main studies( 20 - 22 ) reviewed in the meta-analysis by Pfannschmidt,( 15 ) which leads us to agree with the opinion of those authors who claim that the different protocols for the different types of primary tumor may hinder the understanding of the true impact on the survival of patients undergoing complementary treatment.…”

Section: Discussioncontrasting

confidence: 97%

“…In the study by Pfannschmidt et al.,( 15 ) the perioperative mortality rate ranged from 0% to 2.02%, whereas, in the study conducted in Brazil by Younes et al,( 8 ) the rate was 0.4%. These results are in good agreement with the value of 1.9% found in the present study, showing the safety of the method.…”

Section: Discussionmentioning

confidence: 91%

“…( 15 , 16 ) However, since we calculated survival from treatment of the primary tumor, we observed that various studies reported much lower results, given that, in them, survival was calculated from resection of the metastasis. For instance, in the study by Younes et al,( 8 ) survival at 60 months ranged from 10% to 40%, depending on the primary tumor site.…”

Section: Discussionmentioning

confidence: 97%

“…Most studies have evaluated survival by stratifying patients based on the presence of one resected lesion or multiple resected lesions, with better results being found in patients with single lesions. ( 8 , 10 , 14 ) However, those same authors reviewed controversial results from various studies that did not find significant differences in the survival of patients with multiple nodules,( 17 , 18 ) and the difference in results may lie in the heterogeneity of the biological behavior of the different histological types of tumors studied, suggesting the need for larger, specific studies of this variable.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to the treatment of bilateral lesions, we found that overall survival was 63% in the patients with bilateral disease at diagnosis and 55% in those with unilateral disease, i.e., the difference was not statistically significant, which is in agreement with the findings of the few studies that have addressed this issue and highlights the importance of resection in bilateral disease. ( 8 )…”

Section: Discussionmentioning

confidence: 99%

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Descriptive analysis of and overall survival after surgical treatment of lung metastases

et al. 2013

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OBJECTIVE: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. METHODS: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. RESULTS: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). CONCLUSIONS: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Descriptive analysis of and overall survival after surgical treatment of lung metastases

et al. 2013

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Surgical Resection of Unilateral Lung Metastases: Is Bilateral Thoracotomy Necessary?

2002

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adenocarcinoma (25%), osteosarcoma (23%), squamous cell carcinoma (18%), soft-tissue sarcoma (18%), and other (16%). Median follow-up was 17 months. Contralateral disease-free survival and overall survival were determined. Univariate and multivariate analyses were performed to determine prognostic factors for overall and contralateral disease-free survival. The two groups of patients with confirmed bilateral metastases (synchronous or metachronous) were compared. Actuarial overall 5-year survival was 34.9%. Contralateral recurrence-free 6-month, 12-month, and 5-year survival were 95%, 89%, and 78%, respectively. Patients who experienced recurrence in the contralateral lung within 3, 6, or 12 months had an overall 5-year survival rate of 24%, 30%, and 37%, respectively. When patients with recurrence in the contralateral lung were compared to patients with bilateral metastases on admission, there was no significant difference in overall survival. Only histology and the number of pathologically proven metastases significantly (p < 0.05) predicted recurrence in the contralateral lung. Bilateral exploration of unilateral lung metastases is not warranted in all cases. Most patients will have only unilateral disease, and delaying contralateral thoracotomy until disease is detected radiologically does not appear to affect outcome.

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Pulmonary Metastases Tumor Doubling Time

Chojniak

Younes

2003

American Journal of Clinical Oncology

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Growth rate is a prognostic factor for pulmonary metastases treatment. We used computed tomography (CT) to quantify tumor doubling time (Tdt) variation of pulmonary metastases in the same patient, from different histologies and sizes. We prospectively evaluated chest CTs of patients with pulmonary metastases under no cancer treatment. Tdt of 408 pulmonary nodules in 21 patients was determined. One hundred twenty-three (30%) remained unaltered, 44 (11%) had reduction, and 241 (59%) increased in size. Nodules that grew presented a mean Tdt of 118 +/- 134 days (range: 22-930 days). There was high intraindividual variability of mean Tdt with no difference between histologies. Smaller nodules presented greater tendency to grow, and lower Tdt. There is large variation in clinical behavior for pulmonary metastases in the same patient. Each nodule should be evaluated independently. Selection of a single nodule to evaluate metastatic disease behavior could influence the therapeutic decision.

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Ressecção cirúrgica de metástases pulmonares: estudo prospectivo em 182 pacientes

Cited by 9 publications

References 26 publications

Descriptive analysis of and overall survival after surgical treatment of lung metastases

Descriptive analysis of and overall survival after surgical treatment of lung metastases

Surgical Resection of Unilateral Lung Metastases: Is Bilateral Thoracotomy Necessary?

Pulmonary Metastases Tumor Doubling Time

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