Chirurgie von Lungenmetastasen

Zusammenfassung

Zwischen 1975 und 1985 wurden 76 Patienten mit Lungenmetastasen an der Lungenklinik Hemer operiert. Nach 1 Jahr lebten 86%, nach 3 Jahren 35% und nach 5 Jahren noch 18%. Die mediane Überlebenszeit (ÜL-Zeit) betrug 22 Monate.

Von prognostischer Bedeutung sind: der Tumortyp, die Zahl der Metastasen, das Intervall zwischen Primärtumoroperation und Lungenmetastasektomie sowie die Art der Operation. Voraussetzung für eine Lungenmetastasektomie sind: radikale Entfernung des Primärtumors, Metastasen nur in der Lunge, technische Operabilität der Metastasen und ein akzeptables Operationsrisiko. Die Ergebnisse werden insgesamt als ermutigend angesehen.

Abstract

Between 1975 and 1985 76 patients underwent surgery of pulmonary metastases in our hospital. Most often the primary tumor was located in carcinomas of the colon and rectum (19 patients), followed by carcinomas of the kidney (14 patients), the breast (13 patients) and the skin (malignant melanoma: 9 patients). Conditions for pulmonary metastasectomy are radical removal of the primary tumor, metastases located only in the lung, resectability of the metastases and low operative risk. Three years after pulmonary metastasectomy 35 % of the patients were still alive, the 5 year survival rate was 18%. The median survival time was 22 months. The prognosis in patients with pulmonary metastases is largely dependant upon tumor type. Pulmonary metastases of breast carcinomas and carcinomas of colon and rectum can be treated best by surgical intervention. (5 year survival rate: 35% and 33%). Hypernephroma and malignant melanoma have a 5 year survival rate of 0% and 23%. Other prognostic factors are the number of pulmonary metastases and the disease-free interval between surgery of the primary tumor and pulmonary metastasectomy. Furthermore resection techniques are of prognostic importance. Lobectomy and segmental resection showed a better 5 year survival rate than pneumonectomy (21%, 24%, 0%). Median sternotomy is recommended as standard access for pulmonary metastasectomy. Surgery of pulmonary metastases is encouraging.

Key words

Pulmonary metastases - Surgical treatment - Prognostic factors