Lung metastases of renal cell carcinoma: results of surgical resection

OBJECTIVE

The research was designed to evaluate the results of surgical resection of renal lung metastases.

METHODS

Between 1960 and 1994, 50 consecutive patients underwent resection for pulmonary metastases from renal cell carcinoma. Mean age was 59 years (range: 40-78 years). Mean time between nephrectomy and pulmonary resection was 3 years (range: 0-18 years). Nineteen patients had solitary metastase, 13 multiple unilateral, and 18 bilateral. Wedge excision was performed in 28 patients, segmentectomy in 3, lobectomy in 17, sleeve lobectomy in 1, pneumonectomy in 5 and biopsy in 3. Twelve patients had repeat resection for recurrent metastases.

RESULTS

The resection was complete in 45 patients. Three patients also had a complete resection of limited extra-pulmonary disease. There was one postoperative death and 3 complications. Mean follow-up was 42 months without loss of follow-up. The cause of death was always metastatic recurrent disease. Five-year survival in complete resection was 44%. Only one long survivor was observed in the case of incomplete resection in a patient who had a complete response after adjuvant immunotherapy. Five-year survival for the 12 patients with repeat resections was similar to the overall survival rate (42%).

CONCLUSIONS

Resection of renal lung metastases is a safe and effective treatment. No factor influenced the 5-year survival in this series except the complete resection. Extra-pulmonary metastases does not contra-indicate pulmonary resection. In selected patients, repeat resection for recurrent disease is warranted.

Results and prognostic factors in resections of primary tracheal tumors: a multicenter retrospective study. The French Society of Cardiovascular Surgery

To determine long-term survival and prognostic factors, 208 patients with primary tracheal tumors were evaluated in a retrospective multicenter study including 26 centers. Ninety-four patients had squamous cell carcinoma, four had adenocarcinoma, 65 had adenoid cystic carcinoma, and 45 patients had miscellaneous tumors. The following resections were performed: tracheal resection with primary anastomosis, 165; carinal resection, 24; and laryngotracheal resection, 19. Postoperative mortality rate was 10.5% and correlated with the length of the resection, the need for a laryngeal release, the type of resection, and the histologic type of the cancer. Fifty-nine percent of patients with tracheal cancer and 43% of patients with adenoid cystic carcinomas had postoperative radiotherapy. The 5- and 10-year survivals, respectively, were 73% and 57% for adenoid cystic carcinomas and 47% and 36% for tracheal cancers (p < 0.05). Among patients with tracheal cancers, survival was significantly longer for those with complete resections than for those with incomplete resections. On the other hand, the presence of positive lymph nodes did not seem to decrease survival. Postoperative radiotherapy increased survival only in the case of incompletely resected tracheal cancers. Long-term prognosis was worsened by the occurrence of second primary malignancies in patients with tracheal cancers and by the occurrence of late pulmonary metastases in patients with adenoid cystic carcinomas.

[Results of surgical treatment of lung metastases from colorectal cancers]

OBJECTIVE

The aim of this work was to determine the long term results and the prognostic factors after surgical resection of pulmonary metastases from colorectal cancers.

METHODS

Clinical status after surgery and survival were studied in 101 consecutive patients undergoing lung resection for pulmonary metastases from colorectal carcinoma between 1970 and 1993. Prognostic factors were evaluated according to surgical design. Mean interval between colon resection and lung resection was 44 months. Fifty-nine patients had a solitary lesion, 17 had multiple unilateral lesions and 25 multiple bilateral lesions. Eighteen patients had undergone previous surgery for localized extrapulmonary metastases. A wedge resection was performed in 47 patients, lobectomy or bilobectomy in 40, pneumonectomy in 11 and biopsy in 3.

RESULTS

There was no postoperative mortality and 5-year survival in complete resection was 21%; all patients with incomplete resection or biopsy died within 3 years. Significant prognostic factors were: complete resection, metachronous disease (vs synchronous metastases) and absence of lymph node involvement. The extent of the colorectal disease and the number of resected metastases did not influence prognosis. Survival for patients with resected extrapulmonary disease was not significantly different as compared with patients with only pulmonary metastases. Eleven patients had repeat pulmonary resections, 6 of these patients are currently alive, 3 of them more than 3 years after the second pulmonary resection.

CONCLUSIONS

We conclude that resection of colorectal lung metastases is safe and effective, that resectable extrapulmonary disease does not contra-indicate pulmonary resection and that repeat thoracotomy is warranted in selected patients with recurrent lung metastases.

Thoracoscopic ultrasonic localisation of lung nodules: initial results of an in-vitro and in-vivo study

The main problem in thoracoscopic resection of lung nodules is the difficulty in localising the target. In the following we describe the use of an ultrasonographic, deflectable linear array probe of 7.5 MHz which was first tested during an in-vitro study. This study has provided useful information with respect to the US inspection of normal parenchyma and lung nodules. Initial results in clinical use in 14 patients demonstrate some limitations linked to the difficulty in manoeuvering the probe and to the remaining air in the parenchyma. However, endoscopic US is an interesting additional tool during thoracoscopic exploration of the lung.

Thoracoscopic esophagectomy: technique and initial results

To reduce the high morbidity rate associated with esophageal surgery, we have developed a technique of thoracoscopic esophagectomy. A feasibility study was first carried out in an animal model and a specific instrument was developed for this purpose. Esophagectomy using a right thoracoscopic approach was attempted in 15 patients, 13 males and 2 females whose average age was 48 years. Indications consisted of squamous cell carcinoma in 10 patients, adenocarcinoma in 1, and caustic stenosis in 4. We used a technique that consisted of double-lumen tracheal intubation and the creation of five ports. The whole esophagus was mobilized thoracoscopically and the esophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through, and the anastomosis was made in the neck. There were three failures: in 1 patient there was a large tumor, making the exposure unsafe, and, in 2 patients, incomplete lung collapse made exposure of the posterior mediastinum difficult. These 3 cases were converted into a thoracotomy. The thoracoscopic dissection was successful in the remaining 12 patients. The average time of the thoracoscopic stage was 125 minutes. The postoperative course was uneventful in 10 patients. Two patients had a left atelectasis. Although our series is limited, these initial results indicate that thoracoscopic esophagectomy is feasible. However, further evaluation of the technique is needed to assess its benefit in terms of respiratory morbidity.

Technical aspects of endoscopic removal of benign tumors of the esophagus

We describe the technique of thoracoscopic removal of benign tumors of the esophagus. The technical problems of this new approach are described in the context of our initial experience of four cases.

Laparoscopic splenectomy: initial laboratory experience

An experimental study was conducted in an animal model to test the feasibility of laparoscopic splenectomy. Twelve pigs were operated on. The splenectomy was feasible in 10 cases. However, a splenic injury occurred in five cases and the average blood loss was 80 ccm. We concluded that laparoscopy is feasible in an experimental model but is not a safe and easy procedure. Clinical applications should probably be limited to selected cases.