[Mediastinal lymphadenectomy in surgery of pulmonary metastasis].
ABSTRACT The effect of lymphadenectomy in pulmonary metastasectomy is unceratain. Good indication and right radicality of resection are to-days surgery possibilities to manage the best patient survival. Next possibility is performance of systematic mediastinal lymphdenecomy for currative effect and increasing of staging quality for indication of adjuvant therapy by metatatic lymphnode involvement. The answer about performance of mediastinal lyphadenectomy and its kind was seeked by authors in retrospective study in years 1999-2008. Hundred and six patient underwent pulmonary metastasectomy, 34% patients were of sarcomatous origin. Mediastinal lymhadenectomy was made in 31% patients. There were found the lyphnode involvement in five cases. The group of own patiens is non homogenous for exact conclusion of impact mediastinal lymphadenectomy on survival after pulmonary metastasectomy. The comparison of patient survival with diferent kind of lymphadenectomy isn't acceptable because sampling of lymphonodes may be false negative. For exact comparison of mediastinal lymphadenectomy importance is necessary to do systematic mediastinal lymphadenectomy in prospective multicentric study.
Full-textDOI: · Available from: Marek Szkorupa, Mar 09, 2015
Article: Chirurgie orgánových metastáz /
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ABSTRACT: Die Lymphknotendissektion ist im Hinblick auf die Stadienzuordnung fester Bestandteil der in kurativer Absicht vorgenommenen Operation bei Bronchialcarcinom. Tumorbefall ipsilateraler mediastinaler Lymphknoten (N2) ist mit einer schlechten Prognose vergesellschaftet. Da die meisten Patienten mit N2-Situation innerhalb 3 Jahren nach Operation an Fernmetastasen versterben, muß angenommen werden, daß ein Befall mediastinaler Lymphknoten bereits Ausdruck einer Generalisation der Tumorerkrankung ist. Daher ist einerseits die Wahrscheinlichkeit eines therapeutischen Effekts einer ausgedehnten Lymphknotendissektion gering, andererseits die Evaluation und Anwendung einer zusätzlichen systemischen Therapie gerechtfertigt. Any operation for lung cancer that is planned as curative includes dissection of the lymph nodes in the mediastinum in order to allow correct staging of the disease. It is well known that ipsilateral lymph node metastases (N2) mean a poor prognosis. Since most patients with this finding die from metastatic tumor progression within 3 years after the operation, it can be assumed that positive findings in the mediastinal lymph nodes represent generalization of the cancer. Therefore, the probability of a therapeutic effect from more radical removal of lymph nodes in the mediastinum is rather low. On the other hand, it is justified to apply and evaluate additional systemic treatment in these tumor stages.Der Chirurg 04/1998; 69(4):412-417. DOI:10.1007/s001040050431 · 0.52 Impact Factor
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ABSTRACT: Factors affecting recurrence and survival after pulmonary resection for metastatic osteosarcomas are controversial. To confirm a role for resection of pulmonary metastases for such tumors, we herein reviewed our institutional experience. Between 1989 and 2007, 23 patients with pulmonary metastases from osteosarcomas of the extremities underwent pulmonary resection. Various perioperative variables were investigated retrospectively to confirm a role for metastasectomy and to analyze prognostic factors for overall survival and disease-free survival after metastasectomy. Overall survival rate after metastasectomy was 31% at 5 years. Disease-free survival rate was 19% at 5 years after pulmonary resection. On multivariate analysis, patients with less than five pulmonary metastases and patients without pulmonary metastases identified during pre- and postoperative chemotherapy presented significantly favorable overall survival (p=0.015 and 0.0082, respectively). Furthermore, the number of pulmonary metastases less than five was the only significantly favorable prognostic factor for disease-free survival on univariate analysis (p=0.0055). Current practice of pulmonary metastasectomy for osteosarcomas in our institution was well justified. The number of pulmonary metastases more than five and the advent of pulmonary metastases during pre- and postoperative chemotherapy seemed relevant to a worse prognosis.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2008; 34(6):1235-9. DOI:10.1016/j.ejcts.2008.07.032 · 2.81 Impact Factor