Abstract
Today, pulmonary resection for lung metastases is a widely accepted treatment if complete resection can be achieved. However, 5-year survival is only 40 %. Many patients develop recurrences, but some reports have demonstrated that salvage operations can result in a long-term survival. A resection of a complete lung or a resection of more than a lung is still controversial since procedure-related morbidity or mortality does not outweigh the survival benefit. We report on a series of 10 consecutive patients who underwent a primary pneumonectomy or an operation on the residual lung after pneumonectomy with curative intent for pulmonary metastases. 5 year survival rates for the 10 patients after pneumonectomy alone or with additional resection was 45 %, which was not significantly different from those who underwent a more minor resection with a 5-year survival of 39 % (p = 0.40). Since there is currently no alternative proven therapy for patients with isolated pulmonary metastases, a primary or completion pneumonectomy may be offered to selected patients as long as sufficient pulmonary reserve is present, and a complete resection can be achieved.
Key words
Lung metastases - thoracic surgery - pneumonectomy
References
-
1
McCormack P, Bains M, Beattie E, Martini N.
Pulmonary resection in metastatic carcinoma.
Chest.
1978;
73
163-166
-
2
Pastorino U, Buyse M, Friedel G. et al .
Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. The International Registry for Lung Metastases.
J Thorac Cardiovasc Surg.
1997;
113
37-49
-
3
Hendriks J M, Romijn S, van Putte B. et al .
Long-term results of surgical resection of lung metastases.
Acta Chir Belg.
2001;
101
267-272
-
4
Pogrebniak H, Roth J, Steinberg S, Rosenberg S, Pass H.
Reoperative pulmonary resection in patients with soft tissue sarcoma.
Ann Thorac Surg.
1991;
52
197-203
-
5
Casson A G, Putnam J B, Natarajan G. et al .
Efficacy of pulmonary metastasectomy for recurrent soft tissue sarcoma.
J Surg Oncol.
1991;
47
1-4
-
6
Hendriks J M, van Schil P E, Schrijvers D.
Bilateral pulmonary resection for lung metastases: report of two cases.
Eur J Surg Oncol.
1999;
25
552-553
-
7
Naruke T, Suemasu K, Ishikawa S.
Lymph node mapping and curability at various levels of metastasis in resected lung cancer.
J Thorac Cardiovasc Surg.
1978;
76
832-839
-
8
Me G overn, Trastek V, Pairolero P, Payne W.
Completion pneumonectomy: indications, complications and results.
Ann Thorac Surg.
1988;
46
141-146
-
9
Putnam J.
Douglas M, Natarajan G. Roth J. Extended resection of pulmonary metastases: is the risk justified?.
Ann Thorac Surg.
1993;
55
1440-1446
-
10
Al-Kattan K, Goldstraw P.
Completion pneumonectomy: indications and outcome.
J Thorac Cardiovasc Surg.
1995;
110
1125-1129
-
11
Spaggiari L, Grunenwald H, Gerard Ph, Solli P, Le Chevalier Th.
Pneumonectomy for lung metastases: indications, risks, and outcome.
Ann Thorac Surg.
1998;
66
1930-1933
-
12
Koong H, Pastorino U, Ginsberg R. for the International Registry of Lung Metastases .
Is there a role for pneumonectomy in pulmonary metastases?.
Ann Thorac Surg.
1999;
68
2039-2043
-
13
Bernard A, Deschamps C, Allen M. et al .
Pneumonectomy for malignant disease: factors affecting early morbidity and mortality.
J Thorac Cardiovasc Surg.
2001;
121
1076-1082
-
14
van Geel A, Pastorino U, Jauch K. et al .
Surgical treatment of lung metastases: The European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group study of 255 patients.
Cancer.
1996;
77
675-682
-
15
Kandioler D, Kromer E, Tuchler H. et al .
Long-term results after repeated surgical removal of pulmonary metastases.
Ann Thorac Surg.
1998;
65
909-912
-
16
Jaklitsch M, Mery C, Lukanich J. et al .
Sequential thoracic metastasectomy prolongs survival by reestablishing local control within the chest.
J Thorac Cardiovasc Surg.
2001;
121
657-667
-
17
Grunenwald D, Spaggiari L, Girard P h.
Baldeyrou P, Filaire M, Dennewald G. Completion pneumonectomy for lung metastases: is it justified?.
Eur J Cardiothorac Surg.
1997;
12
694-697
-
18
Weksler B, Burt M.
Isolated lung perfusion with antineoplastic agents for pulmonary metastases. In: Faber LP, McCormack PM eds. Chest Surgery Clinics of North America. Metastatic disease to the lung. Pennsylvania: W.B.
Saunders.
1998;
8
157-182
-
19 Hendriks J M. Pulmonary metastases. Therapeutic Application of Isolated Lung Perfusion. PhD Thesis, Antwerp University 2001
-
20
Burt M, Liu D, Abolhoda A. et al .
Isolated lung perfusion for patients with unresectable metastases from sarcoma: a phase I trial.
Ann Thorac Surg.
2000;
69
1542-1549
Dr. J. Hendriks
Department of Thoracic and Vascular Surgery, University Hospital Antwerp (UZA)
Wilrijkstraat 10
2650 Edegem
Belgium
Phone: +32 (3) 821 31 48
Fax: +32 (3) 825 13 08
Email: jeroen.hendriks@uza.be