| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1997;63:611-612
© 1997 The Society of Thoracic Surgeons
Department of Cardiothoracic Surgery, University Hospital, Umeå, Sweden
| The first 300 words of the full text of this article appear below. |
See also page 777.
As a junior doctor I reviewed a series of pulmonary metastasectomies (PM-ectomies). In 70 patients the 5-year survival was 31%. I concluded that patients with solitary pulmonary metastases (PM) should undergo operation. However, an older and respected physician asked whether such an apparently favorable result might be due to selection mechanisms. To answer the challenge, I consulted with a pulmonary physician friend. He had studied the medical aspects of PM in general [1] and put his material at my disposal. Reviewing his cases, I found 12 patients who fulfilled operation criteria and would have nowadays been operated upon. These patients had a 5-year survival of 25%. Thus survival after metastasectomy could be due to selection mechanisms [2].
Malignant tumors constitute a heterogeneous disease. Even within each tumor type, there is a marked heterogeneity as regards biological aggressiveness also in tumors with poor prognosis. Nöu [3] showed, for instance, in a 5-year epidemiologic review of lung cancer, that there was a tail of outliers with a comparatively long survival after diagnosis also in unoperated patients.
If any treatment is directed primarily to patients with a favorable spontaneous prognosis, an apparently good effect of the treatment may be construed. Patients considered for PM-ectomy are selected by the criteria for operation. The primary tumor has been removed and no other organ metastases are found (this weeds out patients with spread disease). Locally, the disease is eradicated (this weeds out patients with local recurrence). Some kind of interval between the primary organ operation and the metastasectomy is often advocated (this gives the tumor the chance of showing its real nature). The patient is suitable for operation by ordinary criteria (this weeds out patients with poor prognosis from other diseases). Patients thus are selected out
Related Article
Ann. Thorac. Surg. 1997 63: 777-784.
This article has been cited by other articles:
|
|
 |
|
  T. Treasure Editorial comment: Surgical resection of pulmonary metastases Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 354 - 355. [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Brundage, D. Davies, and W. J. Mackillop Prognostic Factors in Non-small Cell Lung Cancer* : A Decade of Progress Chest, September 1, 2002; 122(3): 1037 - 1057. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Jaklitsch, C. M. Mery, J. M. Lukanich, W. G. Richards, R. Bueno, S. J. Swanson, S. J. Mentzer, B. D. Davis, E. N. Allred, and D. J. Sugarbaker Sequential thoracic metastasectomy prolongs survival by re-establishing local control within the chest J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 657 - 667. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. B. Zwischenberger and S. K. Alpard Pulmonary metastasectomy Ann. Thorac. Surg., July 1, 1999; 68(1): 287 - 288. [Full Text] [PDF]
|
|
|
|
|
|
B. J. Robinson, T. W. Rice, S. A. Strong, L. A. Rybicki, and E. H. Blackstone IS RESECTION OF PULMONARY AND HEPATIC METASTASES WARRANTED IN PATIENTS WITH COLORECTAL CANCER? J. Thorac. Cardiovasc. Surg., January 1, 1999; 117(1): 66 - 76. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
