Chirurgie von Lungenmetastasen

Abstract

Between 1975 and 1985 76 patients underwent surgery of pulmonary metastases in our hospital. Most often the primary tumor was located in carcinomas of the colon and rectum (19 patients), followed by carcinomas of the kidney (14 patients), the breast (13 patients) and the skin (malignant melanoma: 9 patients). Conditions for pulmonary metastasectomy are radical removal of the primary tumor, metastases located only in the lung, resectability of the metastases and low operative risk. Three years after pulmonary metastasectomy 35% of the patients were still alive, the 5 year survival rate was 18%. The median survival time was 22 months. The prognosis in patients with pulmonary metastases is largely dependant upon tumor type. Pulmonary metastases of breast carcinomas and carcinomas of colon and rectum can be treated best by surgical intervention. (5 year survival rate: 35% and 33%). Hypernephroma and malignant melanoma have a 5 year survival rate of 0% and 23%. Other prognostic factors are the number of pulmonary metastases and the disease-free interval between surgery of the primary tumor and pulmonary metastasectomy. Furthermore resection techniques are of prognostic importance. Lobectomy and segmental resection showed a better 5 year survival rate than pneumonectomy (21%, 24%, 0%). Median sternotomy is recommended as standard access for pulmonary metastasectomy. Surgery of pulmonary metastases is encouraging.

Surgical Approach to Pulmonary Metastases from Breast Cancer

“…(38%) and Chen et al. (51%)(2,6,12–14). Our results with median survival time of 38.8 months adds further weight to the argument that surgical resection of lung metastases from breast cancer gives improvement in survival.…”

“…From 1940 to 1960 pulmonary metastasectomy was performed infrequently and only in carefully selected patients. Now, the practice of pulmonary resections for solitary metastatic diseases, especially for colorectal cancer, has been well documented (6,7). According to Mc Cormack the criteria for pulmonary resections are: the patient’s ability to tolerate the operation, absence of extrapulmonary metastases, locoregional extent of the disease with primary tumor control, and the extent of pulmonary resection (resectable) (8).…”

Thoracoscopic techniques for the management of intrathoracic metastases Results

“…Factors other than histogenesis that seem to impact on survival include number of metastases, size, and favorable biologic behavior as indicated by prolonged disease-free interval or long tumor doubling time [3,31,47]. Unlike primary non-small-cell lung cancer, there is less controversy regarding the extent of resection, and nonanatomic wedge resections are most commonly performed [10,34,44]. However, controversy exists regarding the best operative approach.…”

Video-assisted thoracoscopic wedge resection of solitary pulmonary metastasis from hepatocellular carcinoma

“…Recent advances in imaging diagnosis have made it possible to detect small HCCs, and such treatments as operation and percutaneous transhepatic ethanol injection (PEI) have contributed to prolongation of survival 3,4. However, distant metastases occasionally limit the efficacy of these treatments …”