[Pulmonary metastasectomy after pneumonectomy].
INTRODUCTION, OBJECTIVES: Authors of two thoracic surgical departments from the above named hospitals discuss their practices of pulmonary metastasectomy after pneumonectomy for malignant disease.


METHODS
Six patients were operated after pneumonectomy for metastatic spread in the residual lung. The average age of the three male and three female patients was 52.5 years. The applied preoperative diagnostical methods were the following: chest-x-ray, CT scan, MRI, PET-CT scan, perfusion lung scintigraphy, bronchological examinations, functional respiratory tests, ECG, cardiac echo, arterial blood gases (ABGs) and other laboratory analyses. Patient selection for operation was based on strict oncological and cardiorespiratory criteria. Finally, the authors describe the applied operative technique; atypical mechanical resection with stapler.


RESULTS
Mean length of postoperative intensive care was between 3 to 7 days, while that of hospitalization altogether was 13 to 18 days (average 15.2 days). Ventilation needed for one patient for 5 days approximately. Two of the six patients' survival was 18 and 25 months after pulmonary metastasectomy. Four patients are still alive, their average postoperative survival is 33.5 months. They are followed up regularly and their quality of life is satisfactory.


CONCLUSIONS
The key factors that determine the successful outcome of metastasectomies are careful and personalized evaluation of the patients, their condition and fitness for thoracotomy, stabile cardiopulmonary functions and the capacity of the residual lung. Multidisciplinary teamwork involving anaesthetists and intensive care specialists along with surgeons using the quick atypical resection technique are the key elements to improved survival of these patients.
Vincze
Károly
K
Kaposi Mór Oktató Kórház, Altalános Sebészeti, Er- és Mellkassebészeti Osztály, 7400 Kaposvár, Tallián Gyula u. 20-32. vinczek@kmmk.hu
Balogh
Gábor
G
Bátor
Gyozo
G
Kecskés
László
L
Patak
Krisztina
K
Muskát
Judit
J
D003422:Critical Care; D005260:Female; D006801:Humans; D006814:Hungary; D007362:Intensive Care Units; D007902:Length of Stay; D008175:Lung Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011013:Pneumonectomy; D011788:Quality of Life; D012086:Reoperation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016019:Survival Analysis; D013537:Sutures; D016896:Treatment Outcome