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Vol. 44. Issue 10.
Pages 525-530 (January 2008)
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Vol. 44. Issue 10.
Pages 525-530 (January 2008)
Original Articles
DOI: 10.1016/S1579-2129(08)60098-1
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Resection of Pulmonary Metastases in 148 Patients: Analysis of Prognostic Factors
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Javier Ayarra Jarne
Corresponding author
javierayarra@tecnifip.com

Correspondence: Dr J. Ayarra Jarne Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena Avda. Dr. Fedriani, s/n 41071 Sevilla, Spain
, Rafael Jiménez Merchán, Miguel Congregado Loscertales, Juan Carlos Girón Arjona, Gregorio Gallardo Valera, Ana Isabel Triviño Ramírez, Carlos Arenas Linares, Jesús Loscertales
Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
Article information
Objective

To evaluate the prognostic factors for survival in a series of patients who underwent surgery for pulmonary metastases from primary tumors in distinct organs.

Patients and Methods

This was a retrospective study of 148 patients operated between May 2001 and May 2007. Multivariate analysis was used to evaluate overall survival. Patients scheduled for tumorectomy were included provided their primary tumor was controlled and they had no extrathoracic recurrence and adequate cardiorespiratory function. The influence of the following prognostic factors was analyzed: number and diameter of the metastases, lymph node infiltration, complete resection, and, above all, histological type. A significance level of 95% was used.

Results

A total of 90 men (60.81%) and 58 women (39.19%) were operated. The mean (SD) age was 56.5 (9.7) years. The actuarial survival at 6 years was 30.3% (n=45) and the median survival was 34 months. The factors that affected survival were the number of metastases (P<.05), diameter of the lesions (P<.05), lymph node infiltration (P<.05), complete resection (P<.05), and, above all, histological type (P<.05). Tumorectomy was the most commonly performed operation.

Conclusions

These results suggest that, in the absence of other therapeutic options and contraindications, we should operate on patients in whom the primary tumor is controlled and in whom complete resection can be performed. Even if factors associated with poor prognosis are present, the outcomes are always better than when surgery is not performed, particularly in view of the relatively low morbidity and mortality associated with this type of surgery.

Key words:
Pulmonary metastases
Pulmonary resection
Video-assisted thoracoscopic surgery
Risk factors
Prognosis
Survival
Objetivo

Evaluar los factores pronósticos de supervivencia en una serie de pacientes intervenidos por metástasis pulmonares de diferentes tumores y órganos.

Pacientes Y Métodos

Se ha realizado un estudio retrospectivo de 148 pacientes intervenidos entre mayo de 2001 y mayo de 2007, y se ha aplicado un análisis multivariante para valorar la supervivencia global. Los criterios de inclusión fueron: control del tumor primario, sin recurrencia extratorácica y función cardiorrespiratoria suficiente, siempre con intención de tumorectomía. Se valoró qué influencia tenían en el pronóstico los siguientes factores: número de metástasis, diámetro de éstas, adenopatías invadidas, cirugía completa y, sobre todo, tipo histológico, para un nivel de significación del 95%.

Resultados

En total se intervino a 90 varones (60,81%) y 58 mujeres (39,19%). La edad media ± desviación estándar era de 56,5 ± 9,7 años. Se obtuvo una supervivencia actuarial a 6 años del 30,3% (n = 45), con una mediana de supervivencia de 34 meses. Los factores que influyeron en el pronóstico fueron el número de metástasis (p < 0,05), el diámetro de éstas (p < 0,05), la presencia de adenopatías invadidas (p < 0,05), la cirugía completa (p < 0,05) y, sobre todo, el tipo histológico (p < 0,05). La tumorectomía fue la intervención más realizada.

Conclusiones

Los resultados avalan que aceptemos para tratamiento quirúrgico a los pacientes sin otra posibilidad terapéutica a quienes pueda realizarse una resección completa, que tengan el tumor primario controlado y no presenten otras contraindicaciones, pues, aunque en presencia de ciertos factores empeora la supervivencia, los resultados son siempre mejores que con la abstención quirúrgica, máxime si se tienen en cuenta las cifras relativamente bajas de morbilidad y mortalidad con este tipo de cirugía.

Palabras clave:
Metástasis pulmonares
Resección pulmonar
VATS
Factores de riesgo
Pronóstico
Supervivencia
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Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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