Surgery of the Pulmonary Metastases

Česká verzia

Authors: M. Szkorupa ¹; T. Bohanes ¹; Č. Neoral ¹; J. Chudáček ¹; K. Langová ²
Authors place of work: I. chirurgická klinika LF UP a FN Olomouc ¹; Ústav lékařské biofyziky LF UP v Olomouci ²
Published in the journal: Klin Onkol 2013; 26(1): 35-41
Category: Original Articles

Summary

Introduction:
Surgical resection of lung metastases of epithelial and mesenchymal tumors has an irreplaceable position in the complex treatment of advanced stages of these malignancies. Among the most significant prognostic factors affecting longterm survival of these patients are: parameter of complete resection, number and size of metastases, histological type of primary tumor, lymph node involvement, DFI (Disease Free Interval) and biological aggressiveness of the tumor or TDT (Tumor Doubling Time).

Aim:
retrospective analysis of patients with lung metastases of epithelial and mesenchymal tumors operated on at the I. Department of Surgery from 2005 to 2011.

Material and Methods:
The authors present a set of 50 patients and evaluation of their age, gender, type of primary tumor, number of metastases, occurrence of bilateral metastases, repeat metastasectomies, duration of DFI, type of operation and selected approach and performance of mediastinal lymphadenectomy. The probability of five-year survival, relationship between survival on DFI, difference in survival between metastases of colorectal cancer versus renal cancer and the influence of repeated metastasectomies and number of metastases on survival were statistically analyzed.

Results:
Sixty operations were performed on a set of 50 patients (average age 61.2 years). Forty-two procedures were performed by thoracotomic approach. A solitary metastasis was discovered in 43 patients; in 8 patients, more than 3 metastases were resected. Repeated metastasectomies were performed 10 times. Mediastinal lymphadenectomy was performed in 21 cases. The most frequent procedure was extraanatomic resection (28×). Fourteen patients had DFI < 12 months, 19 patients had DFI 12–36 months and 17 patients had DFI > 36 months. Average survival was 66.9 months; the probability of five-year survival was 0.549 (54.9%). A relationship between DFI and survival was not discovered. There was no statistically significant difference in survival after metastasectomy for colorectal cancer and renal cancer. A relationship between survival interval and number of metastases and repeated metastasectomies was not discovered.

Conclusion:
Surgical resection of lung metastases plays an important role in multidisciplinary care, assuming a precise selection of patients indicated for this treatment. When properly adhering to the indication criteria, very positive results of long-term survival may be expected.

Key words:
lung – neoplasm metastases – metastasectomy – prognosis – survival

Zdroje

1. Jacklitsch MT, Ravi S, Carlos MM et al. Surgical resection of pulmonary metastases: Benefits; indications; preoperative evaluation and techniques. In: UpToDate [online]. 2011 [cit. 2012-04-24]. Dostupné z: http://www.uptodate.com/contents/surgical-resection-of-pulmonary-metastases-benefits-indications-preoperative-evaluation-and--techniques.

2. Kondo H, Okumura T, Ohde Y et al. Surgical treatment for metastatic malignancies. Pulmonary metastasis: indications and outcomes. Int J Clin Oncol 2005; 10(2): 81–85.

3. Riad NY, Abdo LF, Jefferson LG. Pulmonary metastasectomy: a multivariate analysis of 440 patients undergoing complete resection. Interact Cardiovasc Thorac Surg 2012; 14(2): 156–161.

4. Koong HN, Pastorino U, Ginsberg RJ. Is there a role for pneumonectomy in pulmonary metastases? International Registry of Lung Metastases. Ann Thorac Surg 1999; 68(6): 2039–2043.

5. Pastorino U, Buyse M, Friedel G et al. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. The International Registry of Lung Metastases. J Thorac Cardiovasc Surg 1997; 113(1): 37–49.

6. Treasure T, Fallowfield L, Lees B. Pulmonary Metastasectomy in Colorectal Cancer The PulMiCC Trial. J Thorac Oncol 2010; 5(6): 203–206.

7. Villeneuve PJ, Sundaresan RS. Surgical Management of Colorectal Lung Metastasis. Clin Colon Rectal Surg 2009; 22(4): 233–241.

8. Detterbeck FC, Grodzki T, Gleeson F et al. Imaging requirements in the practice of pulmonary metastasectomy. J Thorac Oncol 2010; 5(6): 134–139.

9. Internullo E, Cassivi S, van Raemdonck D et al. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol 2008; 3(11): 1257–1266.

10. Pastorino U, Veronesi G, Landoni C et al. Fluorodeoxyglucose positron emission tomography improves preoperative staging of resectable lung metastasis. J Thorac Cardiovasc Surg 2003; 126(6): 1906–1910.

11. Kaifi JT, Gusani NJ, Deshaies I et al. Indications and approach to surgical resection of lung metastases. J Surg Oncol 2010; 102(2): 187–195.

12. McCormack PM, Bains MS, Begg CB et al. Role of videoassisted thoracic surgery in the treatment of pulmonary metastases: Results of a prospective trial. Ann Thorac Surg 1996; 62(1): 213–216.

13. Tanaka Y, Maniwa Y, Nishio W et al. The optimal timing to resect pulmonary metastasis. Eur J Cardiothorac Surg 2008; 33(6): 1135–1138.

14. Younes RN, Gross JL, Deheinzelin D. Surgical resection of unilateral lung metastases: Is bilateral thoracotomy necessary? World J Surg 2002; 26(9): 1112–1116.

15. Landreneau RJ, De Giacomo T, Mack MJ et al. Therapeutic video-assisted thoracoscopic surgical resection of colorectal pulmonary metastases. Eur J Cardiothorac Surg 2000; 18(6): 671–676.

16. Carballo M, Maish MS, Jaroszewski DE et al. Video-assisted thoracic surgery (VATS) as a safe alternative for the resection of pulmonary metastases: a retrospective cohort study. J Cardiothorac Surg 2009; 4: 13.

17. Nakajima J, Takamoto S, Tanaka M et al. Thoracoscopic surgery and conventional open thoracotomy in metastatic lung cancer. Surg Endosc 2001; 15(8): 849–853.

18. Kandioler D, Kromer E, Tuchler H et al. Long-term results after repeated surgical removal of pulmonary metastases. Ann Thorac Surg 1998; 65(4): 909–912.

19. Pogrebniak HW, Roth JA, Steinberg SM et al. Reoperative pulmonary resection in patients with metastatic soft tissue sarcoma. Ann Thorac Surg 1991; 52(2): 197–203.

20. Ogata Y, Matono K, Hayashi A et al. Repeat pulmonary resection for isolated recurrent lung metastases yields results comparable to those after first pulmonary resection in colorectal cancer. World J Surg 2005; 29(3): 363–368.

21. Liebl LS, Elson F, Quaas A et al. Value of repeat resection for survival in pulmonary metastases from soft tissue sarcoma. Anticancer Res 2007; 27(4C): 2897–2902.

22. Pfannschmidt J, Muley T, Hoffmann H et al. Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: Experiences in 167 patients. J Thorac Cardiovasc Surg 2003; 126(3): 732–739.

23. Piltz S, Meimarakis G, Wichmann MW et al. Long-term results after pulmonary resection of renal cell carcinoma metastases. Ann Thorac Surg 2002; 73(4): 1082–1087.

24. Vodička J, Špidlen V, Šimánek V et al. Možnosti a výsledky chirurgické léčby plicních metastáz světlobuněčného (konvenčního) renálního karcinomu. Klin Onkol 2011; 24(4): 293–297.

25. Doležel J, Veverková L, Jedlička V et al. Mediastinální lymfadenektomie v chirurgii plicních metastáz. Rozhl Chir 2008; 88(5): 259–261.

26. Čapov I, Wechsler J, Jedlička V et al. Současný stav chirurgie plicních metastáz – review. Klin Onkol 2004; 17(3): 85–90.

27. Welter S, Jacobs J, Krbek T et al. Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg 2007; 31(2): 167–172.

28. Veronesi G, Petrella F, Leo F et al. Prognostic role of lymph node involvement in lung metastasectomy. J Thorac Cardiovasc Surg 2007; 133(4): 967–972.

29. Pfannschmidt J, Hoffmann H, Muley T et al. Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma. Ann Thorac Surg 2002; 74(5): 1653–1657.

30. Pfannschmidt J, Klode J, Muley T et al. Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients. Ann Thorac Surg 2006; 81(2): 448–454.

31. Murthy SC, Kim K, Rice TW et al. Can we predict long--term survival after pulmonary metastasectomy for renal cell carcinoma? Ann Thorac Surg 2005; 79(3): 996–1003.

32. Todd TR. The surgical treatment of pulmonary metastases. Chest 1997; 112 (4 Suppl): 287S–290S.

33. Monteiro A, Arce N, Bernardo J et al. Surgical resection of lung metastases from epithelial tumors. Ann Thorac Surg 2004; 77(2): 431–437.