SURGERY FOR MULTIPLE BILATERAL PULMONARY METASTASES

Victor A.Tarasov, Maria V.Vinogradova, Yuriy K.Sharov, Evgeny S.Pobegalov, Igor V.L’vov

Medical Academy of Postgraduate Education, St.Petersburg, Russia

 

PURPOSE: to accuratize indications for one- and two-staged pulmonary metastasectomies.

MATERIAL AND METHODS. 40 patients (24 female, 16 male, aged 17 – 64, mean - 36+-2.6 years) underwent surgery for multiple bilateral pulmonary metastases of carcinomas (21), sarcomas (17), melanomas (2). Number of metastases varied from 4 to 84 (mean – 13.5+-4.5). To evaluate extent of pulmonary affection, we developed a quantitative criterion: Mct = N x D (N – number of metastases; D – average diameter of metastases), which made up 3 – 53 cm (mean 13.5+-4.2 cm). One-staged metastasectomy was performed in 13 (32.5%) cases, two-staged with an interval of 2 – 12 weeks – in 27 (67.5%).

RESULTS. Complete metastasectomy was achieved in 35 (87.5%) cases, with 22.5% morbidity and 15.0% mortality rates. Cause of all 6 deaths was respiratory failure. Other complications included sternal osteomyelitis (1), loculated pleural empyema (2). Survival time made up 3 – 84 months, median 29.3+-2.1 months.

CONCLUSIONS. Pulmonary metastasectomy may provide prolonged survival time even for patients with dozens of metastases. Complete bilateral metastasectomy is possible in functionally compensated patients with Mct <= 60 cm. One-staged bilateral pulmonary metastasectomy is possible in absence of lobar or segmental bronchial invasion and Mct <= 10 cm.

 

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