Manschettenresektionen in der Metastasenchirurgie der Lunge : Indikation- Technik- Ergebnisse

Central and endobronchial metastases have a poor prognosis. Few case series report results on the treatment of endobronchial metastases respectively sleeve resections in metastatic surgery. An influence of endobronchial metastasis resection on survival is suspected. Surgical case series originate mainly from the 1980s. They show a significant reduction of survival in case of endobronchial metastasis. The aim of the present study was to examine whether this observation persists in a current patient population. The investigated collective included all patients who underwent sleeve resection for central or endobronchial metastases of extrapulmonary malignancies between 1999 and 2017. This monocentric study recorded the course of treatment prospectively, the data analysis was retrospective. In 38 of the 48 patients treated, endobronchial metastases were the indication for the sleeve lobectomy. Colorectal carcinoma (33.3%) and renal cell carcinoma (20.8%) were the main treated entities. Only six patients (12,2%) had a solitary lung metastasis. 16 patients (12.6%) had bilateral metastases at the time of sleeve resection, in eleven patients (68.8%) a complete metastasectomy was performed sequentially. Six types of sleeve resection were used, upper sleeve lobectomies were predominant, bronchovascular sleeve resections accounted for 32.7% (n=16). Morbidity and mortality were 34.7% and 0%, respectively. The R0, R1 and R2 resection rates were 93.9%, 6.1% and 0%, respectively. The average number of metastases resected was 2.56. 68.8% of patients (n=33) had lymph node involvement. Endobronchial recurrence was not observed in any patient during follow-up. The median survival was 33 months (95% CI 20.8- 45.2 months). The 1-, 3-, 5- and 10- year survival rates were 83%, 48%, 40% and 31%, respectively. An influence of the underlying disease on the survival after resection could be assumed. The preoperative evidence of endobronchial metastasis had no influence on survival, nor was there a correlation between the mechanism of endobronchial metastasis and survival. Lymph node involvement did not influence survival (p=0.727). Incomplete resections were associated with a significantly shorter survival (p=0.010). The occurrence of extrathoracic metastases during the course had a highly significant impact on the probability of survival (p=0.000). If a new lung metastases occurred and were resectable long- term survival is possible. To the best of the author's knowledge, this paper describes the largest patient series with endobronchial metastases that was surgically treated with sleeve resection. Compared to conservative studies, survival was in some cases more than 20 months longer. The present study was able to show the connection between endobronchial metastasis resection and prolonged survival, which had been suspected until now. Sleeve resections could be performed with less strict selection than pneumonectomies in metastatic surgery. Resection of endobronchial metastasis was a local therapy to treat acute exacerbation of a tumor disease. In some cases, a permanent general remission of the disease was achieved. Sleeve resections for lung metastases were performed with the same safety and radicality as lung cancer resections. The high proportion of extrathoracic recurrences required a close follow-up. Even in the case of full remission of the disease after resection, adjuvant systemic therapeutic measures should be decided on in an individual case. Sleeve resections had an excellent local control in endobronchial and central metastases. The complication rates corresponded to those of lung carcinoma surgery. They could also be applied in the case of a nodal positive stage and in bilateral cases.