Chirurgie plicních metastáz

Introduction: Surgical resection of lung metastases of epithelial and mesenchymal tumors has an irreplaceable position in the complex treatment of advanced stages of these malignancies. Among the most significant prognostic factors affecting longterm survival of these patients are the parameter of complete resection, the number and size of metastases, the histological type of the primary tumor, lymph node involvement, DFI (disease free interval), biological aggressiveness of the tumor or TDT (tumor doubling time). Aim: retrospective analysis of patients with lung metastases of epithelial and mesenchymal tumors operated on at the I. Department of Surgery from 2005 to 2011.  Material and Methods: the authors present a set of 50 patients where age, gender, type of primary tumor, number of metastases, occurrence of bilateral metastases, repeat metastasectomies, duration of DFI, type of operation and selected approach and performance of mediastinal lymphadenectomy were evaluated. The probability of five-year survival, relationship between survival on DFI, difference in survival between metastases of colorectal cancer versus renal cancer and the influence of repeated metastasectomies and number of metastases on survival were statistically analyzed. Results: 60 operations were performed on a set of 50 patients (average age 61.2 years). 42 procedures were performed by thoracotomic approach. A solitary metastasis was discovered in 43 patients; in 8 patients more than 3 metastases were resected. Repeat metastasectomies were performed 10x. Mediastinal lymphadenectomy was performed in 21 cases. The most frequent procedure was extraanatomic resection- 28x. Fourteen patients had a DFI 36 months. Average survival was 66.9 months; the probability of five-year survival was 0.549 (54.9 %). A relationship between DFI and survival was not discovered. There was no statistically significant difference in survival after metastasectomy for colorectal cancer and renal cancer. A relationship between survival interval and number of metastases and repeated metastasectomies was not discovered.  Conclusion: Surgical resection of lung metastases plays an important role in multidisciplinary care, assuming a precise selection of patients indicated for this treatment. When properly adhering to the indication criteria, very positive results of longterm survival may be expected.