Viszeralchirurgie 2004; 39(5): 350-357
DOI: 10.1055/s-2004-820419
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Lungenmetastasen - Indikationen und Ergebnisse

Lung Metastases - Indications and ResultsG. Meimarakis1 , S. Piltz1 , K. W. Jauch1 , R. A. Hatz1
  • 1 Klinikum der Universität München, Großhadern
Further Information

Publication History

Publication Date:
29 September 2004 (online)

Zusammenfassung

Verbesserte Operationstechniken und verfeinerte Diagnostik haben die chirurgische Indikationsstellung in der Resektion pulmonaler Metastasen erheblich erweitert (bilaterale/multiple Herde, Rezidive). Metastasen aller Primärtumore wurden mit kumulativen Überlebensraten zwischen 25-50 % reseziert.
Zur Qualitätssicherung werden eine gute Primärtumorkontrolle, fehlende extrapulmonale Metastasen, resektable Metastasen und ausreichende funktionelle Parenchymreserve vorausgesetzt. Die muskelschonende anterolaterale Thorakotomie erlaubt zudem durch die manuelle Palpation den Nachweis nicht vordiagnostizierter Herde. Bei einer kurativen Resektion darf die mediastinale Lymphknotendissektion nicht fehlen. Atypische und anatomische Resektionen sind heutzutage mit einer vertretbaren Komplikations- und Letalitätsrate assoziiert und sollten stets in Hinblick auf einen potenziell kurativen Ansatz abgewogen werden.
Als wichtigster prognostischer Faktor für das Langzeitüberleben hebt sich die Radikalität des Eingriffs hervor, gefolgt von Metastasenanzahl und -größe, tumorfreiem Intervall und Histologie des Primärtumors.
Die Ergebnisse der Lungenmetastasenchirurgie für die spezifischen Primärtumorarten werden anhand der Literaturrecherche kritisch beleuchtet.

Abstract

Improved Operation techniques and sophisticated diagnostics have increased resectability of pulmonary metastases (bilateral/multiple focuses, recurrence). Metastases of primary tumours irrespective of their origin have already been resected, with a cumulative survival rate of 25-50 %
For the quality assurance a good primary tumour control, missing extrapulmonal metastases, resectable metastases, and sufficient remaining pulmonary tissue are basic requirements. The less invasive anterolateral thoracotomy also permits the detection of lesions, previously not diagnosed by manual palpation. The mediastinal lymph node dissection is mandatory for a curative resection. Atypical and anatomical resections are nowadays associated with an acceptable morbidity/mortality and should therefore always be taken into consideration as different options for potentially curative therapies.
The curative resection followed by number and size of metastases, disease free interval and histological type of the primary tumour are the most important prognostic indicators for longterm survival.
Here we review the results of lung metastasectomy for certain primary tumours and critically discuss the findings an the background of the literature.

Literatur

  • 1 Weinlechner P. Tumoren an der Brust und deren Behandlung (Resektion der Rippen, Eröffnung der Brusthöhle, partielle Entfernung der Lunge.  Med Wochenschr, Wien. 1882;  20 590-592
  • 2 Divis G. Ein Beitrag zur operativen Behandlung von Lungengeschwülsten.  Acta Chir Scand. 1927;  62 329-341
  • 3 Barney J D, Churchill E J. Adenocarcinoma of the kidney with metastasis to the lung cured by nephrectomy and lobectomy.  J Urol. 1939;  42 269-276
  • 4 Takita H, Edgerton F, Karakousis C. et al . Surgical management of metastases to the lung.  Surg Gynecol Obstet. 1981;  152 191-194
  • 5 Wong J H, Skinner K A, Kim K A. et al . The role of surgery in the treatment of nonregionally recurrent melanoma.  Surgery. 1993;  113 389-394
  • 6 Martini N, Huvos A G, Mik V. et al . Multiple pulmonary resections in the treatment of osteogenic sarcoma.  Ann Thorac Surg. 1971;  12 271-280
  • 7 Jauch K W, Koebe H G, Piltz S, Hertlein H, Dienemann H. Metastasenchirurgie - Kann Metastasenchirurgie radikal sein?.  Zentralbl Chir. 1993;  118 508-515
  • 8 Wilkins E W, Head J M, Burke J F. Pulmonary resection for metastatic neoplasms in the lung: experience at the Massachusetts General Hospital.  Am J Surg. 1978;  135 480-483
  • 9 Kandioler D, Kromer E, Tuchler H. et al . Long-term results after repeated surgical removal of pulmonary metastases.  Ann Thorac Surg. 1998;  66 989
  • 10 Monteiro A, Arce N, Bernardo J, Eugenio L, Antunes M J. Surgical resection of lung metastases from epithelial tumors.  Ann Thorac Surg. 2004;  77 431-437
  • 11 Groeger A M, Kandioler D, Mueller M R, End A, Eckersberger F, Wolner E. Survival after surgical treatment of recurrent pulmonary metastases.  Eur J Cardiothorac Surg. 1997;  12 703-705
  • 12 Venn G E, Sarin S, Goldstraw P. Survival following pulmonary metastasectomy.  Eur J Cardiothorac Surg. 1989;  3 105-109
  • 13 Martini N, McCormack P M. Evolution of the surgical management of pulmonary metastases. In: McCormack PM (ed). Chest Surg Clin N Am. Saunders, Philadelphia 1998; 13-28
  • 14 Kobayashi K, Kawamura M, Ishiara T. Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer.  J Thorac Cardiovasc Surg. 1999;  118 1090-1096
  • 15 van der Veen A H, van Geel A N, Hop W CJ, Wiggers T. Median Sternotomy: the Preferred Incision for Resection of Lung Metastases.  Eur J Surg. 1998;  164 507-512
  • 16 Wright J O, Brandt B, Ehrenhaft S L. Result of pulmonary resection for metastatic lesions.  J Thorac Cardiovasc Surg. 1982;  83 94-99
  • 17 Koong H N, Pastorino U, Ginsberg R J. Is there a role for pneumonectomy in pulmonary metastases? International Registry of Lung Metastases.  Ann Thorac Surg. 1999;  68 2039-2043
  • 18 Loehe F, Kobinger S, Hatz R A, Helmberger T, Loehrs U, Fuerst H. Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy.  Ann Thorac Surg. 2001;  72 225-229
  • 19 Weng E, Tran L, Rege S. et al . Accuracy and clinical impact of mediastinal lymph node staging with FDG-PET imaging in potentially resectable lung cancer.  Am J Clin Oncol. 2000;  23 47-52
  • 20 Mutsaerts E L, Zoetmulder F A, Meijer S, Baas P, Hart A A, Rutgers E J. Outcome of thoracoscopic pulmonary metastasectomy evaluated by confirmatory thoracotomy.  Ann Thorac Surg. 2001;  72 230-233
  • 21 Okumura S, Kondo H, Tsuboi M. et al . Pulmonary resection for metastatic colorectal cancer: experiences with 159 patients.  J Thorac Cardiovasc Surg. 1996;  112 867-874
  • 22 Inoue M, Kotake Y, Nakagawa K, Fujiwara K, Fukuhara K, Yasumitsu T. Surgery for pulmonary metastases from colorectal carcinoma.  Ann Thorac Surg. 2000;  70 380-383
  • 23 Mineo T C, Ambrogi V, Tonini G, Nofroni I. Pulmonary Metastasectomy: Might the Type of Resection Affect Survival?.  J Surg Oncol. 2001;  76 47-52
  • 24 Watanabe I, Arai T, Ono M. et al . Prognostic factors in resection of pulmonary metastasis from colorectal cancer.  Br J Surg. 2003;  90 1436-1440
  • 25 Abecasis N, Cortez F, Bettencourt A. et al . Surgical Treatment of Lung Metastases: Prognostic Factors for Long-Term Survival.  J Surg Oncol. 1999;  72 193-198
  • 26 Pastorino U, Buyse M, Friedel G. et al . Long-term result of lung metastasectomy: prognostic analyses based on 5 206 cases. The International Registry of Lung Metastases.  J Thorac Cardiovasc Surg. 1997;  113 37-49
  • 27 Piltz S, Meimarakis G, Wichmann M, Oberneder R, Jauch K W, Furst H. Surgical treatment of pulmonary metastases from renal cancer.  Urologe A. 2003;  42 1230-1237
  • 28 Cerfolio R J, Allen M S, Deschamps C. et al . Pulmonary resection of metastatic renal cell carcinoma.  Ann Thorac Surg. 1994;  57 339-344
  • 29 Maldazys J D, deKernion J B. Prognostic factors in metastatic renal carcinoma.  J Urol. 1986;  136 376-379
  • 30 Fourquier P, Regnard J F, Rea S. et al . Lung metastases of renal cell carcinoma: results of surgical resection.  Eur J Cardiothorac Surg. 1997;  11 17-21
  • 31 Piltz S, Meimarakis G, Wichmann M W, Hatz R, Schildberg F W, Fuerst H. Long-term results after pulmonary resection of renal cell carcinoma metastases.  Ann Thorac Surg. 2002;  73 1082-1087
  • 32 Viadana E, Bross I DJ, Pickren J W. Cascade spread of bloodborne metastases in solid and nonsolid cancers of humans. In: Weiss L, Gilbert HA (eds). Pulmonary metastasis. GK Hall, Boston 1978; pp 142-167
  • 33 Kanemitsu Y, Kato T, Hirai T, Yasui K. Preoperative probability model for predicting overall survival after resection of pulmonary metastases from colorectal cancer.  Br J Surg. 2004;  91 112-120
  • 34 Zink S, Kayser G, Gabius H J, Kayser K. Survival, disease-free interval, and associated tumor features in patients with colon/rectal carcinomas and their resected intra-pulmonary metastases.  Eur J Cardiothorac Surg. 2001;  19 908-913
  • 35 van Halteren H K, van Geel A N, Hart A A, Zoetmulder F A. Pulmonary resection for metastases of colorectal origin.  Chest. 1995;  107 1526-1531
  • 36 Sakamoto T, Tsubota N, Iwanaga K, Yuki T, Matsuoka H, Yoshimura M. Pulmonary resection for metastases from colorectal cancer.  Chest. 2001;  119 1069-1072
  • 37 Girard P, Ducreux M, Baldeyrou P. et al . Surgery for lung metastases from colorectal cancer: analysis of prognostic factors.  J Clin Oncol. 1996;  14 2047-2053
  • 38 Vogelsang H, Haas S, Hierholzer C, Berger U, Siewert J R, Präuer H. Factors influencing survival after resection of pulmonary metastases from colorectal cancer.  Br J Surg. 2004;  91 1066-1071
  • 39 Weiss L, Mayhew E. An approach to the therapy of metastases from cancer of the upper rectum: a working hypothesis.  Cancer Drug Deliv. 1985;  2 19-33
  • 40 Sugarbaker P H, Gunderson L L, Wittes R E. Colorectal cancer. In: De Vita VT, Hellmann S, Rosenberg SA (eds). Cancer; principles and practice of oncology. 2nd ed. JB Lippincott, Philadelphia 1987; pp 795-885
  • 41 Piltz S, Dienemann H, Müller C, Schildberg F W. Sequential resection of hepatic and pulmonary metastases in patients with colorecal cancer.  Eur J Surg Oncol. 1996;  22 417
  • 42 Piltz S, Meimarakis G, Wichmann M W, Hatz R, Schildberg F W, Fuerst H. Long-term results after pulmonary resection of renal cell carcinoma metastases.  Ann Thorac Surg. 2002;  73 1082-1087
  • 43 Buchler P, Pfannschmidt J, Rudek B, Dienemann H, Lehnert T. Surgical treatment of hepatic and pulmonary metastases from non-colorectal and non-neuroendocrine carcinoma.  Scand J Surg.. 2002;  1 147-154
  • 44 Minnard F A, Fong Y, Weigel T, Blumgart L, Burt M. Resection of pulmonary and hepatic colorecal metastases. Prco Soc Surg Oncol, Chicago Illinois, 1997. 50th Annual Cancer Symposium: P 71 (abstract)
  • 45 Adam R, Magdeleinat P, Azoulay D, Majno P, Bismuth H. Resection of pulmonary metastases in patients previously operated for liver colorectal metastases (abstract).  Eur J Surg Oncol. 1998;  24 237
  • 46 Bray F, Sankila R, Ferlay J, Parkin D M. Estimates of cancer incidence and mortality in Europe in 1995.  Eur J Cancer. 2002;  38 99-166
  • 47 Jemal A, Thomas A, Murray T, Thun M. Cancer statistics, 2002.  CA Cancer J Clin. 2002;  52 23-47
  • 48 Coleman R E, Rubens R D. The clinical course of bone metastases from breast cancer.  Br J Cancer. 1987;  55 61-66
  • 49 Schlappack O K, Baur M, Steger G, Dittrich C, Moser K. The clinical course of lung metastases from breast cancer.  Klin Wochenschr. 1988;  66 790-795
  • 50 Planchard D, Soria J C, Michiels S. et al . Uncertain benefit from surgery in patients with lung metastases from breast carcinoma.  Cancer. 2004;  100 28-35
  • 51 Dresler C M, Goldberg M. Surgical management of lung metastases: selection factors and results.  Oncology (Huntingt). 1996;  10 649-655
  • 52 Lanza L A, Natarajan G, Roth J A, Putnam J B. Long-term survival after resection of pulmonary metastases from carcinoma of the breast.  Ann Thorac Surg. 1992;  54 244-247
  • 53 Staren E D, Salerno C, Rongione A, Witt T R, Faber L P. Pulmonary resection for metastatic breast cancer.  Arch Surg. 1992;  127 1282-1284
  • 54 Livartowski A, Chapelier A, Beuzeboc P. et al . Surgery of lung metastases of breast cancer: analysis of 40 cases.  Bull Cancer. 1998;  85 799-802
  • 55 Friedel G, Pastorino U, Ginsberg R J. et al . Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases.  Eur J Cardiothorac Surg. 2002;  22 335-344
  • 56 Friedel G, Linder A, Toomes H. The significance of prognostic factors for the resection of pulmonary metastases of breast cancer.  Thorac Cardiovasc Surg. 1994;  42 71-75
  • 57 Harness J K, Thompson N W, McLeod M K. et al . Differentiated thyroid carcinoma in children and adolescents.  World J Surg. 1992;  16 547-554
  • 58 Russell C F, Van Heerden J A, Sizemore G W. et al . The surgical management of medullary thyroid carcinoma.  Ann Surg. 1983;  197 42-48
  • 59 Tan R K, Finley R K, Driscoll D. et al . Anaplastic carcinoma of the thyroid: a 24-year experience.  Head Neck. 1995;  17 41-48
  • 60 Kobayashi T, Asakawa H, Umeshita K. et al . Treatment of 37 patients with anaplastic carcinoma of the thyroid.  Head Neck. 1996;  18 36-41
  • 61 DeGroot L J, Kaplan E L, Shukla M S. et al . Morbidity and mortality in follicular thyroid cancer.  J Clin Endocrinol Metab. 1995;  80 2946-2953
  • 62 Pak H, Gourgiotis L, Chang W I. et al . Role of Metastasectomy in the Management of Thyroid Carcinoma: The NIH Experience.  J Surg Oncol. 2003;  82 10-18
  • 63 Casara D, Rubello D, Saladini G. et al . Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables.  J Nucl Med. 1993;  34 1626-1631
  • 64 Schlumberger M, Challeton C, De Vathaire F. et al . Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma.  J Nucl Med. 1996;  37 598-605
  • 65 Khan J H, McElhinney D B, Rahman S B. et al . Pulmonary Metastases of Endocrine Origin - The Role of Surgery.  Chest. 1998;  114 526-534
  • 66 Mathisen D F, Flye M W, Peabody J. The role of thoracotomy in the management of pulmonary metastases from malignant melanoma.  Ann Thorac Surg. 1979;  27 295-299
  • 67 Dahlback O, Hafstrom L, Johnsson P E. et al . Lung resection for metastatic melanoma.  Clin Oncol. 1980;  6 15-20
  • 68 Pogrebniak H W, Stovroff M, Roth J A. et al . Resection of pulmonary metastases from malignant melanoma: results of a 16 year experience.  Ann Thorac Surg. 1988;  46 20-23
  • 69 Gorenstein L A, Putnam J B, Natarajan G. et al . Improved survival after resection of pulmonary metastases from malignant melanoma.  Ann Thorac Surg. 1991;  52 204-210
  • 70 Meyer T, Merkel S, Goehl J, Hohenberger W. Surgical Therapy for Distant Metastases of Malignant Melanoma.  Cancer. 2000;  89 1983-1991
  • 71 Ollila D W, Morton D L. Surgical resection as the treatment of choice for melanoma metastatic to the lung.  Chest Surg Clin N Am. 1998;  8 183-196
  • 72 Jones W B, Romain K, Erlandson R A. et al . Thoracotomy in the management of gestational choriocarcinoma. A clinicopathologic study.  Cancer. 1993;  72 2175-2181
  • 73 Kumar J, Ilancheran A, Ratnam S S. Pulmonary metastases in gestational trophoblastic disease: A review of 97 cases.  Br J Obstet Gynaecol. 1988;  95 70-74
  • 74 Sisson J C, Giordano T J, Jamadar D A. et al . 131-I treatment of micronodular pulmonary metastases from papillary thyroid carcinoma.  Cancer. 1996;  78 2184-2192
  • 75 Mandelbaum I, Williams S D, Einhorn L H. Aggressive surgical management of testicular carcinoma metastatic to lungs and mediastinum.  Ann Thorac Surg. 1980;  30 224-229
  • 76 Toth L, Bodrogi I, Bak M. et al . Thoracic surgery for testicular cancer patients.  Eur J Surg Oncol. 1993;  19 609-613
  • 77 Hacker N F. Uterine cancer. In: Berek JS, Hacker NF (eds). Practical gynecologic oncology. 2nd ed. Williams & Williams, Baltimore 1994; 285-326
  • 78 Byers L J, Fowler J M, Twiggs L B. Uterus. In: Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE (eds). Clinical Oncology. 2nd ed. Churchill Livingstone, Philadelphia 2000; 1987-2015
  • 79 Vermorken J B. The role of chemotherapy in squamous cell carcinoma of the uterine cervix: a review.  Int J Gynecol Cancer. 1993;  3 129-142
  • 80 Bouros D, Papadakis K, Siafakas N, Fuller A F. Natural history of patients with pulmonary metastases from uterine cancer.  Cancer. 1996;  78 441-447
  • 81 Girard P, Baldeyrou P, Le Chevalier T. et al . Surgical resection of pulmonary metastases. Up to what number?.  Am J Respir Crit Care Med. 1994;  149 469-476
  • 82 Anraku M, Yokoi K, Nakagawa K. et al . Metastatic Lung Tumor Study Group of Japan. Pulmonary metastases from uterine malignancies: results of surgical resection in 133 patients.  J Thorac Cardiovasc Surg. 2004;  127 1107-1112
  • 83 Mountain C F, McMurtrey M J, Hermes K E. Surgery for pulmonary metastasis: a 20-year experience.  Ann Thorac Surg. 1984;  38 323-330
  • 84 Anderson T M, McMahon J J, Nwogu C E. et al . Pulmonary resection in metastatic uterine and cervical malignancies.  Gynecol Oncol. 2001;  83 472-476
  • 85 Imachi M, Tsukamoto N, Matsuyama T, Nakano H. Pulmonary metastasis from carcinoma of the uterine cervix.  Gynecol Oncol. 1989;  33 189-192
  • 86 Chao C, Goldberg M. Surgical treatment of metastatic pulmonary soft-tissue sarcoma.  Oncology (Huntingt). 2000;  14 835-841
  • 87 Choong P F, Pritchard D J, Rock M G, Sim F H, Frassica F J. Survival after pulmonary metastasectomy in soft tissue sarcoma. Prognostic factors in 214 patients.  Acta Orthop Scand. 1995;  66 561-568
  • 88 van Geel A N, van Coevorden F, Blankensteijn J D, Hoekstra H J, Schuurman B, Bruggink E D, Taat C W, Theunissen E B. Surgical treatment of pulmonary metastases from soft tissue sarcomas: a retrospective study in The Netherlands.  J Surg Oncol. 1994;  56 172-177
  • 89 Horan T A, Santiago F F, Araujo L M. The benefit of pulmonary metastectomy for bone and soft tissue sarcomas.  Int Surg. 2000;  85 185-189
  • 90 Verazin G T, Warneke J A, Driscoll D L, Karakousis C, Petrelli N J, Takita H. Resection of lung metastases from soft-tissue sarcomas. A multivariate analysis.  Arch Surg. 1992;  127 1407-1411
  • 91 van Geel A N, Pastorino U, Jauch K W. et al . Surgical Treatment of Lung Metastases - The European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group Study of 255 Patients.  Cancer. 1996;  77 675-682
  • 92 Debled M, Ravaud A, Stockle E, Nguyen B B. Role of adjuvant chemotherapy in the treatment of soft tissue sarcoma.  Bull Cancer. 1997;  84 653-663
  • 93 Mertens W C, Bramwell V H. Adjuvant chemotherapy for soft tissue sarcomas.  Hematol Oncol Clin North Am. 1995;  9 801-815
  • 94 Eckersberger F, Moritz E, Wolner E. Results and prognostic factors after resection of pulmonary metastases.  Eur J Cardiothorac Surg. 1988;  2 433-437
  • 95 Sauter E R, Bolton J S, Willis G W, Farr G H, Sardi A. Improved survival after pulmonary resection of metastatic colorectal carcinoma.  J Surg Oncol. 1990;  43 135-138
  • 96 McDonald M L, Deschamps C, Ilstrup D M, Allen M S, Trastek V F, Pairolero P C. Pulmonary resection for metastatic breast cancer.  Ann Thorac Surg. 1994;  58 1599-1602
  • 97 Baron O, Amini M, Duveau D, Despins P, Sagan C A, Michaud J L. Surgical resection of pulmonary metastases from colorectal carcinoma. Five-year survival and main prognostic factors.  Eur J Cardiothorac Surg. 1996;  10 347-351
  • 98 Robert J H, Ambrogi V, Mermillod B, Dahabreh D, Goldstraw P. Factors influencing long-term survival after lung metastasectomy.  Ann Thorac Surg. 1997;  63 777-784
  • 99 Navarrete C P, Zafra J R, Adiego C S. et al . Surgical treatment of pulmonary metastases: survival study.  Colon Rectum. 2002;  45 468-475
  • 100 Morrow C E, Vassilopoulos P P, Grage T B. Surgical resection for metastatic neoplasms of the lung: experience at the University of Minnesota Hospitals.  Cancer. 1980;  45 2981-2985
  • 101 McCormack P, Burt M, Bains M, Martini N, Rusch V, Ginsberg R. Lung resection for colorectal metastases. 10-year results.  Arch Surg. 1992;  127 1403-1406
  • 102 Karakousis C, Velez A, Driscoll D, Takita H. Metastasectomy in malignant melanoma.  Surgery. 1994;  115 295-302
  • 103 Cozzoli A, Milano S, Cancarini G, Zanotelli T, Cosciani Cunico S. Surgery of lung metastases in renal cell carcinoma.  Br J Urol. 1995;  75 445-447

PD Dr. med. R. A. Hatz

Klinikum der Universität München · Großhadern

Marchioninistr. 15

81377 München

Phone: 0 89/70 95-35 11

Fax: 0 89/70 95-35 08

Email: hatz@gch.med.uni-muenchen.de

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