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Liver AND Lung Metastases
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Liver AND Lung Metastases

Sequential Liver and Lung Resections for Metastases. Sometimes people have liver and lung metastases present at the same time. Resection of both hepatic and pulmonary metastases in highly selected patients is safe. Survival rates seem comparable with those of pulmonary resections alone. Should either liver or lung mets not be surgically resectable, then RFA or other ablative method might be successful. If surgery or ablation cannot be done, neoadjuvant treatment with chemotherapy might downgrade the situation to one that is operable or ablatable.

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Sequential Hepatic and Pulmonary Resections for Metastases. Selected Medical Journal Annotated References
[ ] will indicate editorial comment by the compiler. Some sentences are highlighted in bold, again done by the compiler

Curr Treat Options Oncol. 2002 Dec;3(6):497-505.
Metastasectomy for limited metastases from soft tissue sarcoma.

Abdalla EK, Pisters PW.
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.

"The development of metastatic soft tissue sarcoma (American Joint Committee on Cancer stage IV) is associated with a poor prognosis. Surgical resection of isolated solitary or multiple metastases is the only curative treatment; all other forms of treatment are considered palliative. As with all surgical procedures, patient selection is important to maximize the clinical benefit of metastasectomy and to minimize the risk for treatment-related morbidity. Over the past decade, nonresectional ablative approaches have been developed to manage visceral metastatic disease. These ablative procedures include cryosurgery, radiofrequency tumor ablation, and alcohol injection. All such procedures are considered investigational; outcome should be compared to that achievable with traditional surgical metastasectomy. The optimal sequence of treatments and role for perioperative (combined with metastasectomy) chemotherapy are unknown. Given the potential curative nature of metastasectomy, all patients with metastatic soft tissue sarcoma should be evaluated for the possibility of surgical resection. Patients with good performance status who have radiographically resectable disease should be considered for metastasectomy."
Fetch PMID: 12392639

Ther Umsch. 2001 Dec;58(12):726-31.
[Metastasectomy--a direct therapeutic effect or an illusion due to patient selection?] [Article in German]
Fey MF, Rauch D.
Institut fur medizinische Onkologie, Universitat und Inselspital, Bern.

Metastasectomy is widely practiced in surgical oncology. Well established examples are the resection of liver metastases in patients with colo-rectal cancer, wedge resections of lung metastases in sarcoma, or the surgical removal of solitary brain metastases derived from solid tumours. The latter example has been tested in randomised phase III trials and found to be an effective mode of treatment compared with radiation therapy alone. In the other fields no such trials are available, and data chiefly stem from retro- and prospective phase II trials. For a variety of reasons, phase II studies are not suitable to separate confounding factors such as selection of good-risk patients, stage migration linked to the improvement of preoperative staging techniques, and improved supportive care, from the direct therapeutic effects of the surgical procedure as such. Although desirable, it is unlikely that surgeons and patients would accept randomised trials to reassess evidence levels in this field. In practice, large prospective studies of case series are likely to provide the highest evidence level achievable, and these limitations of the literature should be taken into account in an appropriate fashion when patients with metastatic cancer are advised about options for surgery.
Fetch PMID: 11797535

Langenbecks Arch Chir Suppl Kongressbd 1996;113:225-8
[Results of operative therapy in sequential liver and lung metastasis]. [Article in German]
Piltz S, Dienemann H, Jauch KW, Schildberg FW.
Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Ludwig-Maximilians-Universitat Munchen.

During the last 16 years, 15 patients with colorectal (n = 12), gastric (n = 1), renal cell (n = 1) and adrenal (n = 1) carcinoma underwent sequential resection of both hepatic and pulmonary metastases. Median survival after diagnosis of primary tumor was 80 months (range 23-183), after liver resection 23 (range 10-131), and after lung resection 18 months (range 5-87). Compared to patients with only hepatic (median survival: 38 months) or pulmonary metastases (median survival: 30 months) survival time was not significantly different (p = 0.18).
Fetch PMID: 9101838

Ann Thorac Surg 2001 Mar;71(3):975-9; discussion 979-80
Surgical treatment of hepatic and pulmonary metastases from colon cancer.
Headrick JR, Miller DL, Nagorney DM, Allen MS, Deschamps C, Trastek VF, Pairolero PC.
Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA

...Surgical resection of isolated hepatic or pulmonary metastases secondary to colorectal cancer has been shown to yield acceptable long-term survival. .... CONCLUSIONS: Resection of both hepatic and pulmonary metastases secondary to colorectal cancer in highly selected patients is safe and results in long-term survival. ...[There are a LOT of articles in the literature about sequential liver and lung metastases in hepatocellular carcinoma. Ed.]
Fetch PMID: 11269484

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