Benefits of the Classical Approach in Surgery for Pulmonary Metastases

Česká verzia

Authors: P. Horák; R. Pospíšil ^*; P. Polouček ^**
Authors place of work: Chirurgická klinika 1. LF UK a FN Na Bulovce, přednosta: doc. MUDr. Jan Fanta, DrSc. ; Oblastní nemocnice Kladno, a. s., chirurgické oddělení, primář: MUDr. Ronald Pospíšil ^*; Oblastní nemocnice Příbram, a. s., chirurgické oddělení, primář: MUDr. Jiří Svoboda ^**
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 3, s. 162-165.
Category: Monothematic special - Original

Summary

Introduction:
Distant metastases remain a significant problem in the treatment of malignancies. Surgical management of pulmonary metastases is considered valuable from the oncological view only on condition that R0 resection can be achieved. The whole spectrum of resection procedures can be used, however most commonly, extraanatomic lung resections are employed. It has not been fully evaluated whether the same efficacy can be obtained with thoracoscopic procedures.

Aim of the study:
The aim was to compare the study complication rates with literature data. The secondary aim was to evaluate the benefit of intraoperative lung palpation examination.

Material and Methods:
The authors present a retrospective study in a group of subjects operated for secondary pulmonary malignancies in the Motol Charles University 2nd Medical Faculty and Faculty Hospital Surgical Clinic, from 2003 to 2007. The authors compared the patient group’s morbidity and 30-day mortality rates with literature data. Preoperative CT findings, intraoperative palpation findings and histological examination findings were assessed.

Results:
Postoperative morbidity of the operated subjects was 16.5%, postoperative 30-day mortality was 0%. The authors compared the preoperative diagnostic data based on CT, the intraoperative findings and histological findings. During the total of 77 surgical procedures, including open and VATS procedures, the authors performed intraoperative palpation examination and detected 60 foci (24.6% out of the total removed foci) previously undetected on CT. All of the foci were of less than 5mm and in 55 cases, the foci were proved metastases.

Conclusion:
The outcome data showing low postoperative morbidity rates and nul 30-day mortality have confirmed that pulmonary metastasectomy is a safe method, a part of the complex oncological management. A surgeon’s palpation finding is considered unsubstitutable in the detection of all lung foci and for necessary orientation in order to identify the safety margin in wedge resections. Therefore, the authors prefer the open or videoassissted approach to purely miniinvasive procedures.

Key words:
lung metastases – R0 resection – open approach

Zdroje

1. Viadana, E., Bross, I. D. J., Pickren, J. W. Cascade spread of blood-borne metastases in solid and nonsolid cancers of humans. In: L. Weiss, H. A. Gilbert: Pulmonary metastasis. Boston, GK Hall 1978, s. 142–147.

2. Carney, D. N. Molecular biology of cancer. Ir. J. Med. Sci., 154, 1990, č. 6, s. 171

3. Hohenberger, W., Reck, Th., Ott, R., Forst, R., Fahlbusch, R. Chirurgie metastáz; In: H. D. Becker, W. Hohenberger, T. Junginger, P. M. Schlag: Chirurgická onkologie. 1. vydání. Praha Grada Publishing 2005, s. 736–750.

4. Schildberg, F. W., Meyer, G., Piltz, S., Koebe, H. G. Surgical treatment of tumor metastases: general considerations and results. Surg. Today, 1995, č. 25, s. 1–10.

5. Yamada, H., Katoh, H., Kondo, S., Okushiba, S., Morikawa, T. Surgical treatment of pulmonary recurrence after hepatectomy for colorectal liver metastases. Hepatogastroenterology, 49, 2002, č. 46, s. 976–979.

6. Shah, S. A., Haddad, R,, et al. Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma. J. Am. Coll. Surg., 202, 2006, č. 3, s. 468–475.

7. Jauch, K. W., Koebe, H. G., Piltz, S., Hertlein, H., Dienemann, H. Surgery of metastases – can surgery of metastases be radical? Zentralbl. Chir., 118, 1993, č. 9, s. 508–515.

8. Schildberg, F. W., Fürst, H. Forschritt der bildgebenden Diagnostik im Bereich des Thorax (CT, MRI, Intervention) – Bedeutung und Wertung für den Chirurgen. Langenbecks Arch. Chir. Suppl. II, 1998, 255–260.

9. Schirren, J., Wassenberg, D., Cuenond, R., et al. Surgical therapy of lung metastases. An interdisciplinary responsibility. Radiologe, 1994, č. 34, s. 562–568.

10. Monteiro, A., Arce, N., Bernardo, J., Eugénio, L., Antunes, M. J. Surgical resection of lung metastases from epithelial tumors. Ann. Thorac. Surg., 77, 2004, s. 2, s. 431–437.

11. Roberts, D. G., Cardillo, G., Denervik, I., et al. Long-term follow-up of operative tratment for pulmonary metastases. Eur. J. Cardiothorac. Surg., 1989, č. 3, s. 292–296.