[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to analyse predictive factors for postoperative and long-term outcome after pneumonectomy. From 1 January 2000 to 1 January 2005 a total of 91 (31%) pneumonectomies were performed. Multivariable analysis for postoperative morbidity, mortality, and long-term survival was performed. Patients over 70 years had 1.5 times higher risk of dying (HR=1.5, 95% CI=1.1-2.0) within five years compared to younger patients, those with co-morbidity had 1.8 times higher risk compared to no co-morbidity (HR=1.8, 95% CI=1.3-2.7) and those with stage IIIA had 2.3 times higher risk of dying compared to stage I (HR=2.3, 95% CI=1.5-3.6). Overall postoperative mortality within 30 days in patients undergoing pneumonectomy was 10% (n=9). Most patients who died postoperatively were 70 years or older, had cardiovascular comorbidity and underwent right-sided pneumonectomy (n=6). Patients over 70 years had three times higher risk of complications compared to younger patients (OR=3.1, 95% CI=1.1-8.2), and patients undergoing right-sided pneumonectomy had 2.4 times higher risk compared to left-sided pneumonectomy (OR=2.4, 95% CI=0.9-6.4). Pneumonectomy is accompanied by high postoperative mortality and morbidity rates, the highest risk in patients over 70 years and right-sided pneumonectomy, and consequently should lead to meticulous patient selection and perioperative care.
Interactive Cardiovascular and Thoracic Surgery 06/2009; 9(2):260-4. DOI:10.1510/icvts.2008.194456 · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The lung is the most common extraabdominal site for metastases from colorectal cancer. Patients with untreated metastatic disease have a median survival of less than 10 months and a 5-year survival of less than 5%. The purpose of this study was to evaluate long-term survival in patients who underwent pulmonary resection for metastases from colorectal cancer.
Between January 1990 and January 2005, 23 patients underwent 29 operations for resection of lung metastases.
Median age was 68 years (range: 46-80 years). Median follow-up was 30 months (range: 12-149 months). The 2- and 5-year overall survival rates were 64 and 26%, respectively. Of the 23 patients, 16 patients had a solitary lesion, and seven patients had multiple lesions. The 5-year survival rates were 23 and 33%, respectively (not significant). The median disease-free interval (DFI)--the interval between colon resection and the appearance of lung metastases--was 43 months (1-168). Ten patients had DFIs <36 months, and 13 patients had DFIs >36 months. The 3-year survival rates were 20 and 38%, respectively (not significant). Recurrence of lung metastases was diagnosed in seven patients; three patients underwent second resections. They are alive today, with a median follow-up of 18 months. Patients who did not undergo second resections had a median survival of 12 months.
Pulmonary resection for metastases from colorectal cancer does produce longer survival, even in patients with multiple lesions and recurrent metastases.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 07/2007; 2(7):652-6. DOI:10.1097/JTO.0b013e318074bbb8 · 5.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the therapeutic activity of accelerated cisplatin and high-dose epirubicin with erythropoietin and G-CSF support as induction therapy for patients with stage IIIa-N2 non-small-cell lung cancer (NSCLC). Patients with stage IIIa-N2 NSCLC were enrolled in a phase II trial. They received cisplatin 60 mg m(-2) and epirubicin 135 mg m(-2) every 2 weeks for three courses combined with erythropoietin and G-CSF. Depending on results of clinical response to induction therapy and restaging, patients were treated with surgery or radiotherapy. In total, 61 patients entered from March 2001 to April 2004. During 169 courses of induction chemotherapy, National Cancer Institute of Canada (NCI-C) grade III/IV leucocytopenia was reported in 35 courses (20.7%), NCI-C grade III/IV thrombocytopenia in 26 courses (15.4%) and NCI-C grade III/IV anaemia in six courses (3.6%). Main cause of cisplatin dose reduction was nephrotoxicity (12 courses). Most patients received three courses. There were no chemotherapy-related deaths. Three patients were not evaluable for clinical response. Twenty-eight patients had a partial response (48.3%, 95% CI: 36-61.1%), 24 stable disease and six progressive disease. After induction therapy, 30 patients underwent surgery; complete resection was achieved in 19 procedures (31.1%). Radical radiotherapy was delivered to 25 patients (41%). Six patients were considered unfit for further treatment. Median survival for all patients was 18 months. Response rate of accelerated cisplatin and high-dose epirubicin as induction chemotherapy for stage IIIa-N2 NSCLC patients is not different from more commonly used cisplatin-based regimen.
British Journal of Cancer 09/2006; 95(4):470-4. DOI:10.1038/sj.bjc.6603289 · 4.82 Impact Factor