J.Jpn. Surg. Soc.. 100(2): 216-219, 1999

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Feature topic

SURGICAL TREATMENT OF PULMONARY METASTASES FROM DIGESTIVE ORGANS AND MANAGEMENT OF MALIGNANT PLEURAL EFFUSIONS

This article summarizes the indications for surgical treatment of pulmonary metastases from carcinomas of the digestive organs, mainly the colon and rectum. Survival rates after pulmonary metastasectomy from colorectal carcinomas range from 24％ to 43％ at 5 years, and from 20％ to 34％ at 10 years. However, the survival benefit after metastasectomy from other organs appears questionable. Survival analysis after metastasectomy from colorectal carcinomas shows that patients with fewer metastatic tumors with smaller diameters, complete resection of metastatic foci, no lymph node involvement, no history of extrapulmonary metastases, longer disease-free interval, and a lower serum CEA level at thoracotomy have a better prognosis. Prospective studies are needed to determine which factors are statisticaliy significant for survival. Management of malignant pleural effusions commonly includes thoracenthesis and tube thoracostomy drainage, foilowed by the instillation of various anticancer drugs or sclerosing agents. The application of biological agents such as interleukin-2 and interferons is an experimental treatment under investigation. Thoracoscopy using video-assisted techniques is a new approach for the diagnosis and treatment of malignant pleural effusions.

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