[Surgical treatment of pulmonary metastases--surgical methods, early and long-term results].
OBJECTIVE
To retrospectively evaluate the postoperative results after surgery for lung metastases from extrapulmonary origin.


METHODS
A total of 45 patients were operated on for lung metastases between Jan 1996 and Dec 2006. They were 22 (48.9%) male and 23 (51.1%) female with a mean age of 51.6 years. Unilateral operation was carried out in 34 (75.6%) of the patients and another 11 (24.4%) patients were operated on for bilateral metastases. In 8 of them a one-stage operation was performed via median sternotomy (6) and bilateral successive thoracotomies (2). Two-stage strategy was applied in 3 patients. Metastasectomy via sternotomy as a surgical procedure was performed in all cases with bilateral lesions. In one case with one-stage successive thoracotomies a lobectomy and metastasectomy were used. In the group of unilateral operation the following procedures were carried out: metastasectomy in 23 (51%), lobectomy in 7 (15.6%), extended lobectomy in 2 (4.4%), sleeve lobectomy in 1 (2.2%) and polysegmental resection in 1 (2.2%). VATS was applied in 6 (13.3%) patients.


RESULTS
No 30-day postoperative mortality was faced. There were 3 (6.7%) minor postoperative complications. The mean number of resected metastases was 2.3 per patient. The primary tumor sites were as follow: colorectal carcinoma--15 (33.3%); renal carcinoma--5 (12.1%); breast carcinoma--6 (13.3%); soft tissue fibrosarcoma--6 (13.3%); osteosarcoma--4 (8.9%); melanoma--1 (2.2%); gastric carcinoma--1 (2.2%), thyreoid gland carcinoma--1 (2.2%); suprarenal carcinoma--1 (2.2%) and carcinoma of salivary gland type--1 (2.2%). Mediastinal lymph nodes dissection was carried out in all patients and in 5 (12.1%) was found a metastatic mediastinal lymph nodes involvement. Adequate control of primary site tumor was achieved in all patients. Until the end of the study 01.01.2008, 19 (42.2%) of the patients are alive. The median survival was 38 months with 95% Confidence Interval (33-43). The gender (p=0.194), metastases diameter (p=0.211), mediastinal lymphnode involvement (p=0.102), initial clinical symptoms (p=0.233) and the primary site stage (p=0.091) can not be considered as a prognostic factors. The prognosis was significantly influenced by histology (p=0.0275), but because of small number of cases in the groups result should be interpreted with caution. The disease free interval (p=0.0348) and metastases number > 3 (p=0.0456) are considered prognostic factors.


CONCLUSIONS
Surgery is an integral part of multimodality treatment of lung metastases with low postoperative complication rate and good long-term results. Respectability, "disease free interval" and number of metastases are considered to be the main prognostic factors.
Petrov
D
D
Stanoev
M
M
Plochev
M
M
Goranov
E
E
Dzhambazov
V
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D056346:Sternotomy; D013908:Thoracotomy; D055815:Young Adult