Surgical therapy of pulmonary metastases – 10-year results

Abstract

Introduction:The surgical therapy of selected secondary pulmonary tumors, including both solitary and multiple or bilateral tumours, is currently a generally accepted therapeutic procedure demonstrably extending the long term survival of these patients. Purpose: The purpose of the present study is a ten-year retrospective analysis of a group of patients who underwent surgery due to pulmonary metastases of various primary tumors. Methods: In 2000-2009, 87 patients (of which 44 were male with a median age of 64 years) with secondary pulmonary tumors underwent surgery at the departments of the authors of this study. Solitary metastases were found in 60 patients, multiple metastases in the remaining patients, while 13 patients had bilateral metastases. The median disease-free period from surgery of the primary tumor was 31 months. Results: In total, 74 unilateral and 13 bilateral surgeries were performed in one or two periods. The most common type of surgery included anatomical pulmonary resections (32 procedures), wedge resections (29 procedures) and laser excisions (24 procedures). In total, the radical resection was performed in 156 metastases. Post-operative morbidity was 17.2 % with zero mortality. A proportion of 50.6 % of operated patients survived after resection of metastases with median survival of 39 months. The overall three-year and fi ve-year survivals in the group were 57 % and 38 %, respectively. A proportion of 35.6 % of patients live after resection of metastases without disease progression, and the median is 15 months. Conclusion:The achieved results confi rm the positive role of pulmonary metastasectomy in the therapy of disseminated cancer disease (Tab. 1, Fig. 5, Ref. 34 Hematogeneous pulmonary metastases are generally considered as a sign of advanced generalization of malignant disease. Up to one third of malignant tumors have pulmonary metastases, and in most of them the lungs are even the fi rst site of dissemination. Nevertheless, in a signifi cant number of patients, the pulmonary affl iction is stopped or eliminated during the dissemination of metastases, and these patients may benefi t from radical resection of metastases (1, 2). Surgical therapy of the selected secondary pulmonary tumors, not only solitary but also multiple or bilateral, is today generally the accepted therapeutic procedure which demonstrably extends long term survival of these patients with acceptable peri-operative morbidity and mortality. The purpose of the following study is a retrospective analysis of a group of patients who underwent surgery due to pulmonary metastases of various primary tumors over a period of ten years. Material and methodsIn 2000-2009 we performed surgery on 87 patients with secondary pulmonary tumors. Only patients who had undergone a radical resection of the primary tumor, were free from other extrapulmonary metastases, their pulmonary metastases appeared to be radically removable according to the pre-operative examinations as for the number and location, and the benefi t of surgery...

Nd:YAG Laser surgery of lung metastases

“…In the case of most primary tumors forming lung metastases this operation has been found to improve long-term survival while yielding acceptable levels of morbidity and mortality [1]. However this is only true when certain conditions are fulfilled.…”

“…Patients should be offered the option of bilateral surgery, particularly when they have no significant pulmonary limitations [5]. Sternotomy to remove lung metastases on both sides in a single session is now only rarely performed for this indication [1]. Lung metastases in the left lower lobe and more central foci are particularly difficult to remove using this form of access.…”

“…Lung metastases in the left lower lobe and more central foci are particularly difficult to remove using this form of access. In general, lung metastases should be removed in a manner that preserves the parenchyma so that repeated operations can be carried out if lung metastases recur [1]. If the lung metastases are small and situated on or directly beneath the pleural membrane they can usually be clamped off and then removed.…”

Diagnostics of intrapulmonary metastases from colorectal cancer (literature survey)

“…The level of CEA in serum before thoracotomy is one of the most significant prognostic factors in univariate and multivariate analysis for survival after resection of metastatic tumors of the lungs (15,17,50,64,65). As a whole the increased serum level of CEA is related with the biologic functions of the colorectal carcinoma because its increased expression correlates with bad prognosis not only with organ localization but with its metastatic progression in the lungs (50,64).…”

“…As a whole the increased serum level of CEA is related with the biologic functions of the colorectal carcinoma because its increased expression correlates with bad prognosis not only with organ localization but with its metastatic progression in the lungs (50,64). The size of the tumor, the number of the pulmonary lesions and the metastases in the lymph nodes represent the extent of metastatic pulmonary disease and they appear as prognostic factors similar to these included in TNM classifications (15,66).…”