Pulmonary metastases – 12-year experience with surgical therapy
Authors:
J. Vodička 1; V. Špidlen 1; V. Šimánek 1; J. Šafránek 1; J. Fichtl 1; P. Mukenšnabl 2; M. Roušarová 3
Authors place of work:
Chirurgická klinika, Lékařská fakulta v Plzni, Univerzita Karlova v Praze, Fakultní nemocnice v Plzni, přednosta: Prof. MUDr. V. Třeška, DrSc.
1; Šiklův patologicko-anatomický ústav, Lékařská fakulta v Plzni, Univerzita Karlova v Praze
Fakultní nemocnice v Plzni, přednosta: Prof. MUDr. M. Michal
2; Národní onkologický registr, Fakultní nemocnice v Plzni, vedoucí lékař: MUDr. M. Roušarová
3
Published in the journal:
Rozhl. Chir., 2014, roč. 93, č. 4, s. 194-201.
Category:
Original articles
Podpořeno Institucionálním grantem FN Plzeň číslo 96-44.
Summary
Introduction:
Nowadays, radical surgical therapy of selected secondary pulmonary tumours is a generally accepted therapeutic procedure that has been proven to extend long-term survival of the patients with acceptable perioperative morbidity and mortality. The authors present a retrospective analysis of a set of patients who underwent surgery for pulmonary metastases of various tumours in a 12-year period.
Material and methods:
In 2001–2012, 159 patients with secondary pulmonary tumours were operated on at the authors’ department, of whom 80 were men; the median age was 65 years. Solitary metastases were present in 112 patients (70.4%); the other patients had multiple metastases; 24 patients (15.1 %) suffered from bilateral involvement, and 6 patients (3.8%) suffered from relapsed metastatic disease after previous radical surgery. Colorectal carcinoma metastases were diagnosed in most cases (75 people – 47.2%). The median disease-free period from the surgery of the primary tumour was 27 months in the patient set.
Results:
In total, 166 unilateral (87.4%) and 24 bilateral surgeries were performed using one- or two-stage procedure (12.6%). Precise laser excisions represented the most common type of surgery (59 procedures – 31.1%). In total, 296 metastases were radically resected, and 13 were treated using radiofrequency ablation. Perioperative morbidity was 13.2% with a zero lethality rate. 90 operated patients (56.6%) still survive after the metastasectomy, with median survival of 44 months. The overall 3-year survival in the set was 59%, and 5-year survival was 39%. The number of metastases is a statistically significant factor affecting survival in the patient cohort with colorectal carcinoma metastases, the risk of death being 2.7 times higher in patients with 2 and more colorectal carcinoma metastases. 68 patients (42.8%) live without progression of the disease after the metastasectomy, with the median disease-free interval of 29 months. In total, 43% of the patients were free of any signs of relapse or disease progression for 3 years, and 27% for 5 years. The risk of disease progression is 2.1 times higher in patients with 2 and more metastases of any tumour, and for colorectal carcinoma this risk is 2.3 times higher.
Conclusion:
The achieved results confirm the positive role of pulmonary metastasectomy in disseminated tumour therapy. The number of metastases is the decisive prognostic factor affecting both long-term survival of operated patients and their DFI.
Key words:
pulmonary metastasis – metastasectomy – colorectal cancer – laser – lymphadenectomy
Zdroje
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Perspectives in Surgery
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