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
1. Čapov I, Doležel J, Vlček P, et al. Opakované plicní resekce v chirurgii plicních metastáz. Rozhl Chir 2013;92:694–698.
2. Salah S, Watanabe K, Park JS, et al. Repeated resection of colorectal cancer pulmonary oligometastases: pooled analysis and prognostic assessment. Ann Surg Oncol 2013;20:1955–1961.
3. Kim CH, Huh JW, Kim HJ, et al. Factors influencing oncological outcomes in patients who develop pulmonary metastases after curative resection of colorectal cancer. Dis Colon Rectum 2012;55:459–464.
4. Skalický T, Třeška V, Špidlen V, et al. Chirurgická léčba jaterních a plicních metastáz kolorektálního karcinomu. Rozhl Chir 2010;89:253–255.
5. Třeška V, Vodička J, Špidlen V, et al. Jaterní a plicní metastázy kolorektálního karcinomu – zkušenosti Chirurgické kliniky FN v Plzni. Rozhl Chir 2013;92:488–493.
6. Zisis C, Tsakiridis K, Kougioumtzi I, et al. The management of the advanced colorectal cancer: management of the pulmonary metastases. J Thorac Dis 2013;5:S383–S388.
7. Pfannschmidt J, Egerer G, Bischof M, et al. Surgical intervention for pulmonary metastases. Dtsch Arztebl Int 2012;109:645–651.
8. Internullo E, Cassivi SD, Van Raemdonck D, et al. ESTS Pulmonary Metastasectomy Working Group. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol 2008;3: 1257–1266.
9. Yano T, Shoji F, Maehara Y. Current status of pulmonary metastasectomy from primary epithelial tumors. Surg Today 2009;39:91–97.
10. Doležel J, Jedlička V, Peštál A, et al. Chirurgická léčba plicních metastáz. Rozhl Chir 2012;91:563–567.
11. García-Yuste M, Cassivi S, Paleru C. The number of pulmonary metastases: influence on practice and outcome. J Thorac Oncol 2010;5:S161–163.
12. Hwang MR, Park JW, Kim DY, et al. Early intrapulmonary recurrence after pulmonary metastasectomy related to colorectal cancer. Ann Thorac Surg 2010;90:398–404.
13. Chao YK, Chang HC, Wu YC, et al. Management of lung metastases from colorectal cancer: video-assisted thoracoscopic surgery versus thoracotomy—a case-matched study. Thorac Cardiovasc Surg 2012;60:398–404.
14. Hornbech K, Ravn J, Steinbrüchel DA. Outcome after pulmonary metastasectomy: analysis of 5 years consecutive surgical resections 2002–2006. J Thorac Oncol 2011;6:1733–1740.
15. Nakajima J, Murakawa T, Fukami T, et al. Is thoracoscopic surgery justified to treat pulmonary metastasis from colorectal cancer? Interact Cardiovasc Thorac Surg 2008;7:212–216.
16. Eckardt J, Licht PB. Thoracoscopic versus open pulmonary metastasectomy: a prospective, sequentially controlled study. Chest. 2012;142:1598–602.
17. Cerfolio RJ, Bryant AS, McCarty TP, et al. A prospective study to determine the incidence of non-imaged malignant pulmonary nodules in patients who undergo metastasectomy by thoracotomy with lung palpation. Ann Thorac Surg 2011;91:1696–1700.
18. Jarabo JR, Fernández E, Calatayud J, et al. More than one pulmonary resections or combined lung-liver resection in 79 patients with metastatic colorectal carcinoma. J Surg Oncol 2011;104: 781–6.
19. Horák P, Pospíšil R, Polouček P. Přednosti klasického operačního přístupu v chirurgické léčbě plicních metastáz. Rozhl Chir 2011;90:162–165.
20. Pfannschmidt J, Dienemann H. Current surgical management of pulmonary metastases. Zentralbl Chir 2009;134:418–424.
21. Renaud S, Falcoz PE, Olland A, et al. Should mediastinal lymphadenectomy be performed during lung metastasectomy of renal cell carcinoma? Interact Cardiovasc Thorac Surg 2013;16: 525–528.
22. Chen F, Sakai H, Miyahara R, et al. Repeat resection of pulmonary metastasis is beneficial for patients with colorectal carcinoma. World J Surg 2010;34:2373–2378.
23. Park JS, Kim HK, Choi YS, et al. Outcomes after repeated resection for recurrent pulmonary metastases from colorectal cancer. Ann Oncol 2010;21:1285–1289.
24. Welter S, Theegarten D, Trarbach T, et al. Safety distance in the resection of colorectal lung metastases: a prospective evaluation of satellite tumor cells with immunohistochemistry. J Thorac Cardiovasc Surg 2011;141:1218–1222.
25. Čapov I, Doležel J, Vlček P, et al. Je oprávněné provedení pneumonektomie v léčbě plicních metastáz? Rozhl Chir 2011;90: 631–633.
26. Ding JH, Chua TC, Glenn D, et al. Feasibility of ablation as an alternative to surgical metastasectomy in patients with unresectable sarcoma pulmonary metastases. Interact Cardiovasc Thorac Surg 2009;9:1051–1053.
27. Bargellini I, Bozzi E, Cioni R, et al. Radiofrequency ablation of lung tumours. Insights Imaging 2011;2:567–576.
28. Szöke T, Kortner A, Neu R, et al. Is the mediastinal lymphadenectomy during pulmonary metastasectomy of colorectal cancer necessary? Interact Cardiovasc Thorac Surg 2010;10:694–698.
29. Kudelin N, Bölükbas S, Eberlein M, et al. Metastasectomy with standardized lymph node dissection for metastatic renal cell carcinoma: an 11-year single-center experience. Ann Thorac Surg 2013;96:265–270.
30. Doležel J, Jedlička V, Peštál A, et al. Četnost metastatického postižení mediastinálních uzlin během plicní metastazektomie. Rozhl Chir 2011;90:653–655.
31. Brandi G, Derenzini E, Falcone A, et al. Adjuvant systemic chemotherapy after putative curative resection of colorectal liver and lung metastases. Clin Colorectal Cancer 2013;12:188–194.
32. Gonzalez M, Poncet A, Combescure C, et al. Risk factors for survival after lung metastasectomy in colorectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol 2013;20:572–579.
33. Salah S, Watanabe K, Welter S, et al. Colorectal cancer pulmonary oligometastases: pooled analysis and construction of a clinical lung metastasectomy prognostic model. Ann Oncol 2012;23: 2649–2655.
34. Cho S, Song IH, Yang HC, et al. Prognostic factors of pulmonary metastasis from colorectal carcinoma. Interact Cardiovasc Thorac Surg 2013;17:303–307.
35. Li WH, Peng JJ, Xiang JQ, et al. Oncological outcome of unresectable lung metastases without extrapulmonary metastases in colorectal cancer. World J Gastroenterol 2010;16:3318–3324.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2014 Číslo 4
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Acute periproctal abscesses
- Surgical rectocele repair – many techniques, few unambiguous conclusions
- Complications of hemorrhoids
- Pulmonary metastases – 12-year experience with surgical therapy