[Liver and lung metastases of colorectal cancer. Long-term survival and prognostic factors]. / Leber- und Lungenmetastasen des kolorektalen Karzinoms. Langzeitüberleben und Prognosefaktoren.

INTRODUCTION: The resection of liver and lung metastases from colorectal cancer has not yet been completely investigated. The aim of this study was to investigate the overall survival and prognostic factors for patients with liver and lung metastases from colorectal cancer. METHODS: A retrospective review of a prospective database of 52 patients with liver and lung metastases from colorectal cancer, undergoing metastasectomy with curative intent from 1999-2009 at a single institution was carried out. RESULTS: The mean overall survival (OS) was 64 months. For synchronous liver and lung metastases the mean overall survival was 63 months (5-year survival 54 %) and for metachronous liver and lung metastases 74 months (5-year survival 58 %, p = 0.451). A poor prognostic outcome was observed in cases of localization of the primary tumor in the rectum (OS 81 vs. 38 months, p = 0.004), with multiple lung metastases (≥ 2 metastases, OS 74 vs. 59 months, p = 0.032) and with disease progression after premetastasectomy chemotherapy (OS 74 vs. 63 vs. 15 months, p < 0.001). No influence on overall survival was detected for bilateral lung metastases, thoracic lymph node metastases, disease recurrence and disease-free interval < 36 months. CONCLUSION: Metastasectomy for liver and lung metastases of colorectal cancer is associated with a good overall survival in selected cases. Patients with liver and lung metastases should not be routinely excluded from metastasectomy and patients with thoracic lymph node metastases should also not be routinely excluded. Negative prognostic factors for survival are localization of the tumor in the rectum, multiple metastases and disease progression after premetastasectomy chemotherapy. Patients with disease progression after premetastasectomy chemotherapy should be excluded from metastasectomy.

[Multimodal Treatment of Non-Small Cell Lung Cancer with Cerebral Metastases]. / Multimodale Therapie des zerebral metastasierten nicht kleinzelligen Lungenkarzinoms.

BACKGROUND: The role of surgical treatment of lung cancer with brain metastases remains controversial. The aim of this study was to determine the long-term outcome and to identify potential prognostic factors in patients with cerebral metastatic non-small cell lung cancer (NSCLC). METHODS: The data of patients who underwent a resection of oligometastatic NSCLC with brain metastases from January 1999 to December 2012 were investigated retrospectively at a single institution. Multimodal treatment included resection or radiation surgery of the brain metastases at first, followed by systemic chemotherapy and the surgical treatment of the lung cancer finally. Survival, potential prognostic factors, response to chemotherapy as well as morbidity and mortality were investigated. RESULTS: A total of 105 patients with primary NSCLC and brain metastases was identified. Out of these, 26 patients (18 males, 8 females) were included in the study. Morbidity and mortality rates were 15 and 0 %, respectively. Lobectomies were performed in 15 patients, pneumonectomy in 5 and sleeve lobectomy in 6 patients, respectively. The brain metastases were treated individually by resection (n = 12), stereotactic radiotherapy (n = 11) or whole brain radiotherapy in several combinations. Histological response to chemotherapy was proven in 9.1 %. The 2-year survival rate was 50 % (median survival [MS], 26 months). There were no significant differences of the survival depending on the patients' age, gender, presence of lymph node metastases, number of the brain metastases, type of chemotherapy or response to chemotherapy. Adenocarcinoma as histology of the primary tumour showed a significantly better survival compared to squamous cell carcinoma (MS: 26 vs. 8 months; p = 0.034). Treatment of the brain metastases without any additional whole brain radiation was associated with inferior survival compared to patients with whole brain radiation (mean survival: 17 vs. 73 months; p = 0.005). CONCLUSION: Long-term survival is achievable in highly selected patients with NSCLC and cerebral metastasis by multimodal treatment including resection of the primary lung cancer. Patients with squamous cell carcinoma should be selected carefully for multimodal treatment. Treatment of the brain metastases without whole brain radiation should be avoided.

[Intraoperative bleeding during thoracic surgery : avoidance strategies and surgical treatment concepts]. / Intraoperative Blutungen in der Thoraxchirurgie : Vermeidungsstrategien und chirurgische Therapiekonzepte.

BACKGROUND: As a direct result of the thoracic anatomy, heavy bleeding is possible during nearly all central resections in thoracic surgery. OBJECTIVE: Description of the incidence of intraoperative bleeding including avoidance strategies and treatment concepts. Presentation of special anatomical features of pulmonary arteries. MATERIAL AND METHODS: A literature search was performed in Pubmed, medline and by manual searching. Publications from the last 60 years were analyzed and the results are summarized in a structured review. RESULTS: Little data is available on the incidence of intraoperative bleeding during thoracic surgery. Most data were collected retrospectively. For mediastinoscopy the incidence of severe bleeding is 0.2 %, for minimally invasive anatomical resections the incidence of intraoperative bleeding is 4.7 % and for open surgery 5 %. Bleeding from the central pulmonary artery can take a dramatic course and requires rapid and targeted therapy. DISCUSSION: Knowledge of the anatomical topographic details, the structure, the course and the specific features of the vessels of the lungs is essential to prevent and treat bleeding. Avoidance strategies include techniques of proximal and distal vessel control, intrapericardial preparation and sharp preparation in general. Techniques of forward-looking preparation and well-prepared exit strategies in case of bleeding have to be part of the training in thoracic surgery.

Sleeve resections for the treatment of non-small cell lung cancer.

Parenchyma-sparing sleeve lobectomies were originally developed as a surgical strategy for patients not fit for a pneumonectomy, because of impaired pulmonary function. As promising short- and long-term results were demonstrated, sleeve lobectomy was accepted as an alternative surgical procedure to pneumonectomy. Nowadays, sleeve resections are associated with prolonged long-term survival and better quality of life, compared to pneumonectomy. Therefore, sleeve resections should be performed for centrally located non-small cell lung cancer (NSCLC) whenever technically, anatomically and oncologically possible. In this review, we discuss the current status of sleeve resections in the management of NSCLC.

[Therapy management of chylothorax]. / Therapiemanagement des Chylothorax.

The diagnosis and treatment of chylothorax poses a challenge to the surgeons' daily practice. The leakage of chyle into the thoracic cavity leads to hypovolemia and also to dysfunction of lipid metabolism, electrolyte imbalance, avitaminosis and immunosuppression. If untreated, the disease will have fatal consequences. This article gives a detailed review of the anatomy, physiology, pathophysiology, diagnostics and treatment options in the management of chylothorax.