V.A.Tarasov, Yu.K.Sharov, P.I.Azarov, V.V.Stavrovietskiy, E.S.Pobegalov, M.B.Blum, I.V.Lvov, J.R.Rossina, V.M.Senin, A.V.Senina
BACKGROUND: Management of multiple lung
metastases of malignant tumours is currently a disputable question. Indications
for surgery are not concretized for these patients, there are no distinct
criteria to choose appropriate surgical methods for their treatment. Number of
metastases exceding a dozen is commonly thought to be inoperable. Our studies
show more surgical abilities in management of this condition.
MATERIAL AND METHODS: 21 patient with multiple lung
metastases of different malignant tumours was observed at the Department of
Thoracic Surgery of Medical Academy of Postgraduate Education from September
1995 till March 1997. Primary tumours were breast, colon, thyroid, metral
cancer, hypernephromas, sarcomas, melanoblastoma, teratoblastoma. 20 patients
were operated previously for primary tumours in other hospitals. On admission
to our clinic 15 patients had also recurrencies and distant metastases in other
organs and regions. 9 patients were sheduled to immunotherapy without surgery
due to wide extension of malignancies associated with poor functional tests. 12
patients with lung metastases varying from 3 to 74 in number and from 0,3 to
15,0 cm in diameter underwent surgery. In 5 cases all lung metastases were
removed simultaneously through median sternotomy. In 4 patients bilateral
thoracotomies were performed in 2 stages. 1 patient required a unilateral
thoracotomy only, counterlateral lung being intact. 2 patients survived
first-stage thoracotomies with removal of numerous (12 and 39) metastases but
would not survive a second-stage operation. In 6 cases, recurrencies and
distant metastases of other localizations were also removed.
RESULTS. There was 1 postoperative death
(8,3%) due to progressive respiratory failure after removal of the upper
extremity with scapula, chest wall resection and removal of 74 lung metastases
of neurogenic sarcoma. There were also 2 (16,7%) postoperative complications: 1
intrapleural haemorrage which required a rethoracotomy, and 1 delayed lung
expansion successfully managed by additional active pleural drainage.
Immunotherapy was conducted postoperatively in all cases.
CONCLUSION: Surgical removal of multiple
distant lung metastases is possible and beneficial if surgical sanation of
primary or recurrent tumour and other distant metastases may be performed as
well. Dozens of lung metastases or large-sized ones may be removed with low
mortality and morbidity rate and satisfactory functional results. Further
studies are strongly needed to develop distinct criteria of operability in case
of numerous large metastases.
[Back
to the list of publications]