Arif Osman TOKAT, Sezgin KARASU, Hüseyin ÇAKMAK

Göğüs tomografisi ile değerlendirilen metastatik akciğer tümörleri için açık cerrahi gerekli midir?

Amaç: Bu çalışmada primer tümörler nedeniyle cerrahi olarak tedavi edilen ve akciğer metastazı olan hastaların tomografik değerlendirmeleri ile ameliyat sırası bulguları karşılaştırıldı. Çalışma planı: Çalışmaya akciğer metastazektomisi uygulanan 160 hasta (102 erkek, 58 kadın; ort. yaş 34.6±14.3 yıl; dağılım, 11-64 yıl) dahil edildi. Primer odak cerrahi olarak eksize edildi ve taramalarda akciğeri dışında metastaz tespit edilmedi. Açık cerrahi girişimin bulguları ile ameliyat öncesi tomografik görüntüler değerlendirildi ve karşılaştırıldı. Bulgular: Toplam 296 cerrahi rezeksiyon uygulandı ve 166 açık cerrahi işlemde 345 metastatik lezyon eksize edildi. Direkt radyografilerde lezyon tespit edilmemiş olmasına rağmen 35 hastada (%21.9) tomografik değerlendirmelerde 71 (%20.6) metastatik lezyon tespit edildi. Yirmi dokuz hastada (%18.1) radyolojik olarak tespit edilmemiş olan 33 (%9.6) metastatik lezyon ameliyat sırasında bulundu. Sonuç: Tomografik inceleme maligniteli hastaların takibinde kullanılmaktadır ancak pulmoner metastazlar için yeterli ve etkin değildir. Bu nedenle, radyolojik olarak tespit edilemeyen metastazların ameliyat sırasında tespiti için tercih edilen yaklaşım açık cerrahi olmalıdır. Açık cerrahi rezeksiyon akciğer metastazları için düşük perioperatif morbidite ve mortalite oranları ile güvenilir bir şekilde uygulanabilir.

Is open surgery necessary for metastatic pulmonary tumors evaluated with thorax tomography?

Background: This study aims to compare the tomographic evaluations and intraoperative findings of patients treated surgically for primary tumors and who had pulmonary metastasis.Methods: The study included 160 patients (102 males, 58 females; mean age 34.6±14.3 years; range, 11 to 64 years) who underwent pulmonary metastasectomy. The primary focus was surgically excised and no metastases other than pulmonary were detected on scans. Preoperative tomographic images together with the findings of the open surgical intervention were evaluated and compared.Results: A total of 296 surgical resection were performed and 345 metastatic lesions were excised in 166 open surgical procedures. In 35 patients (21.9%), 71 (20.6%) metastatic lesions were detected in tomographic evaluations although no lesions had been detected on direct radiographs. In 29 patients (18.1%), 33 (9.6%) metastatic lesions, which had not been detected radiologically, were found intraoperatively.Conclusion: Tomographic evaluation is used in the follow-up of patients with malignancy but as for pulmonary metastasis it is not efficient and adequate. Therefore, open surgery should be the preferred approach for intraoperative detection of metastases that cannot be detected radiologically. Open surgical resection for pulmonary metastasis can be performed safely with low rates of perioperative morbidity and mortality.

PDF

___

21. Internullo E, Cassivi SD, Van Raemdonck D, Friedel G, Treasure T. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol 2008;3:1257-66.
20. Cangel G, Turna A, Demirkaya A, Tuzun H, Kaynak K, Demirhan O. Results of resection of pulmonary metastasis and prognostic factors. Turk Gogus Kalp Dama 2014;22:354-62.
19. Mutsaerts EL, Zoetmulder FA, Meijer S, Baas P, Hart AA, Rutgers EJ. Outcome of thoracoscopic pulmonary metastasectomy evaluated by confirmatory thoracotomy. Ann Thorac Surg 2001;72:230-3.
18. Pfannschmidt J, Klode J, Muley T, Dienemann H, Hoffmann H. Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients. Ann Thorac Surg 2006;81:448-54.
17. Kuritzky AM, Aswad BI, Jones RN, Ng T. Lobectomy by Video-Assisted Thoracic Surgery vs Muscle-Sparing Thoracotomy for Stage I Lung Cancer: A Critical Evaluation of Short- and Long-Term Outcomes. J Am Coll Surg 2015;220:1044-53.
16. Nakas A, Klimatsidas MN, Entwisle J, Martin-Ucar AE, Waller DA. Video -assisted versus open pulmonary metastasectomy: the surgeon's finger or the radiologist's eye? Eur J Cardiothorac Surg 2009;36:469-74.
15. Carballo M, Maish MS, Jaroszewski DE, Holmes CE. Video-assisted thoracic surgery (VATS) as a safe alternative for the resection of pulmonary metastases: a retrospective cohort study. J Cardiothorac Surg 2009;4:13.
14. Eckardt J, Licht PB. Thoracoscopic or open surgery for pulmonary metastasectomy: an observer blinded study. Ann Thorac Surg 2014;98:466-9.
13. Downey RJ, Bains MS. Open Surgical Approaches for Pulmonary Metastasectomy. Thorac Surg Clin 2016;26:13-8.
12. Molnar TF, Gebitekin C, Turna A. What are the considerations in the surgical approach in pulmonary metastasectomy? J Thorac Oncol 2010;5:140 -4.
11. Mineo TC, Ambrogi V, Tonini G, Nofroni I. Pulmonary metastasectomy: might the type of resection affect survival? J Surg Oncol 2001;76:47-52.
10. Sawada S, Suehisa H, Ueno T, Sugimoto R, Yamashita M. Monitoring and management of lung cancer patients following curative-intent treatment: clinical utility of 2 -deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/ computed tomography. Lung Cancer (Auckl) 2016;7:45-51.
9. Güven T, Sırmalı M, Türüt H, Fındık G, Gezer S, Kaya S, et al. Outcomes of metastasectomy in secondary tumors of the lung: A retrospective analysis of 74 patients. [Article in Turkish] Türk Göğüs Kalp Damar Cer Derg 2006;14:216-21.
8. Kayton ML, Huvos AG, Casher J, Abramson SJ, Rosen NS, Wexler LH, et al. Computed tomographic scan of the chest underestimates the number of metastatic lesions in osteosarcoma. J Pediatr Surg 2006;41:200-6.
7. Lien HH, Lindsköld L, Fosså SD, Aass N. Computed tomography and conventional radiography in intrathoracic metastases from non-seminomatous testicular tumor. Acta Radiol 1988;29:547-9.
6. Pastorino U, Buyse M, Friedel G, Ginsberg RJ, Girard P, Goldstraw P, et al. Long- term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 1997;113:37-49.
5. Monteiro A, Arce N, Bernardo J, Eugénio L, Antunes MJ. Surgical resection of lung metastases from epithelial tumors. Ann Thorac Surg 2004;77:431-7.
4. Şengül AT, Başoğlu A, Büyükkarabacak YB, Yetim TD, Kutlu T. Assessment of metastasectomy and prognostic factors in the treatment of metastatic lung tumors. Turk Gogus Kalp Dama 2009;17:87-91.
3. Parsons AM, Detterbeck FC, Parker LA. Accuracy of helical CT in the detection of pulmonary metastases: is intraoperative palpation still necessary? Ann Thorac Surg. 2004;78:1910- 6.
2. Ozkan M, Tokat AO, Kavukçu S. Metastatic lung tumours. [Article in Turkish] Tuberk Toraks 2003;51:207-15.
1. Yenigun BM, Yuksel C, Enon S, Ozkan M, Cangir AK, Kutlay H. Prognostic factors in metastasectomy of lung metastases from colorectal cancer. Turk Gogus Kalp Dama 2015;23:75-81.