Outcome after pulmonary metastasectomy:analysis of 5 years consecutive surgical resections 2002-2006

IntroductionIn this study, we analyze the results of management of pulmonary metastases in 5 years consecutive operations at our institution. We aim to define the patients who are most likely to benefit from surgery by investigating long-term survival and prognostic factors associated with prolonged survival.MethodsThe data on all consecutive patients between 2002 and 2006 were reviewed retrospectively. One hundred seventy-eight patients underwent 256 surgical resections for suspected pulmonary metastases from different primary malignancies. Prognostic factors analyzed included age, sex, surgical approach, surgical resection, number of metastases, distribution of metastases, disease-free interval, presence of synchronous metastases, recurrence of disease, prior liver resection (colorectal cancer), and tumor histology (sarcomas).ResultsComplete resection was achieved in 248 cases (96.8%). The mean follow-up was 61.6 months. Five-year survival with respect to primary malignancy was colorectal carcinoma (50.3%), sarcoma (21.7%), malignant melanoma (25.0%), renal cell carcinoma (51.4%), and miscellaneous malignancies (50.0%). Of the prognostic factors analyzed by univariate analysis, none was found to be significant in all the different groups of cancers.ConclusionsPulmonary metastasectomy is a safe and effective treatment that may be associated with prolonged survival in highly selected patients. Low morbidity and mortality rates in contrast with the lack of any other effective treatment justify the aggressive approach of surgery. Thoracoscopic resection is a valid option in selected patients. In case of recurrence of pulmonary disease and if the patient fulfils the initial criteria for pulmonary metastasectomy, repeat surgery should be performed. Solid prognostic factors still need to be established

Coagulation profile in patients undergoing video-assisted thoracoscopic lobectomy: A randomized, controlled trial.

BACKGROUND:Knowledge about the impact of Low-Molecular-Weight Heparin (LMWH) on the coagulation system in patients undergoing minimal invasive lung cancer surgery is sparse. The aim of this study was to assess the effect of LMWH on the coagulation system in patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer. METHODS:Sixty-three patients diagnosed with primary lung cancer undergoing VATS lobectomy were randomized to either subcutaneous injection with dalteparin (Fragmin®) 5000 IE once daily or no intervention. Coagulation was assessed pre-, peri-, and the first two days postoperatively by standard coagulation blood test, thromboelastometry (ROTEM®) and thrombin generation. RESULTS:Patients undergoing potential curative surgery for lung cancer were not hypercoagulable preoperatively. There was no statistically significant difference in the majority of the assessed coagulation parameters after LMWH, except that the no intervention group had a higher peak thrombin and a shorter INTEM clotting time on the first postoperative day and a lower fibrinogen level on the second postoperative day. A lower level of fibrin d-dimer in the LMWH group was found on the 1. and 2.postoperative day, although not statistical significant. No differences were found between the two groups in the amount of bleeding or number of thromboembolic events. CONCLUSIONS:Use of LMWH administered once daily as thromboprophylaxis did not alter the coagulation profile per se. As the present study primarily evaluated biochemical endpoints, further studies using clinical endpoints are needed in regards of an optimized thromboprophylaxis approach

Baseline data (preoperative) from 63 patients planned for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.

<p>Baseline data (preoperative) from 63 patients planned for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.</p

Anti-factor Xa data from 32 patients planned for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer and randomized to receive Low-Molecular-Weight Heparin (LMWH).

<p>Anti-factor Xa data from 32 patients planned for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer and randomized to receive Low-Molecular-Weight Heparin (LMWH).</p

Trial flowchart for patients planned for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.

<p>*: Estimated with some uncertainty. ^<b>1</b><b>: This includes: 1) Patients operated on Thursday and Fridays; 2) No specialized laboratory technicians available; 3) Not practical possible to get permission from the patient to participate; 4) Other logistic problems.</b> Abbreviations: n/N: numbers; ASA: Acetylsalicylic acid (aspirin); LMWH: Low-Molecular-Weight Heparin; NSAID: Non-Steroid Anti Inflammatory Drug.</p

Peri- and postoperative data from 63 patients planned for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.

<p>Peri- and postoperative data from 63 patients planned for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.</p

ROTEM^® results among 63 patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.

<p>ROTEM^® results among 63 patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.</p