초록접수 현황
| 15F-102 | 포럼 발표 |
Long-term Results of Pulmonary Metastasectomy in Pediatric and Adolescent Patients
김민석, 박인규, 강창현, 김영태
서울대학교 의과대학 서울대학교병원 흉부외과학교실
Background : The lung is one of common sites of metastatic malignant tumors, and surgery is indicated to determine the histology of tumor and to resect metastatic pulmonary nodules. The aims of this study were (1) to estimate long-term survival, (2) to analyze risk factors of late mortalities, and (3) to compare the differences between 2 surgical strategies, VATS versus thoracotomy, in pediatric and adolescent patients who underwent pulmonary metastasectomy.
Methods : The records of 60 pediatric/adolescent patients (age <20 years; 36 males) who underwent pulmonary metastasectomy between January 2003 and March 2015 were retrospectively reviewed. Patient characteristics, such as age at diagnosis, histology of the primary tumor, time to development of metastasis, number of involved lung lobes, laterality of pulmonary metastasis, number of nodules on radiologic findings, number of metastasis, size of the metastatic nodules, type of surgery, completeness of excision, were examined. Median ages at diagnosis of primary tumor and at the first pulmonary metastasectomy were 13.2 and 14.2 years, respectively. During the study period, 110 pulmonary metastsectomies (57 VATS, 52 thoracotomies, 1 sternotomy) were performed in 60 patients. The primary tumors were osteoblastoma (n=36), Wilm’s tumor (n=5), hepatoblastoma (n=4), rhabdomyosarcoma (n=3), synovial sarcoma (n=3), Yolk sac tumor (n=2), epitheloid sarcoma (n=1), clear cell sarcoma (n=1), malignant peripheral nerve sheath tumor (n=1), Ewing’s sarcoma (n=1), mucinous adenocarcinoma (n=1), hepatocellular carcinoma (n=1), and giant cell tumor (n=1). The median follow-up after metastatic diagnosis was 10.2 years.
Results : During the follow-up, 13 patients died. Five- and 10-year survival rates were 84.9% and 73.8%, respectively. In univariate analysis, existence of extrapulmonary metastasis (p=0.010), number of resected nodules (p=0.014), number of biopsy-proven metastasis (p=0.013), and maximum size of metastatic nodule (p=0.024) were the risk factors for late mortality. However, no parameter was significantly associated with late mortality in multivariable analysis. Compared with the VATS group, the thoracotomy group showed significantly larger number of pulmonary metastasis on preoperative CT (p<0.001) and resected nodules (p<0.001), and longer time to remove chest tube (p<0.001), although there was no difference in late mortality (p=0.400).
Conclusion : Pulmonary metastasectomy in pediatric/adolescent patient demonstrated an overall 10-year survival rate of 73.8%. Appropriate patient selection should be performed before surgery, and the patient should be free of recurrent or residual disease of the primary tumor, or of extrapulmonary metastasis. Although thoracotomy metastasectomy removed a larger number of metastatic nodules than VATS metastasectomy, no difference in late mortality was observed.
Methods : The records of 60 pediatric/adolescent patients (age <20 years; 36 males) who underwent pulmonary metastasectomy between January 2003 and March 2015 were retrospectively reviewed. Patient characteristics, such as age at diagnosis, histology of the primary tumor, time to development of metastasis, number of involved lung lobes, laterality of pulmonary metastasis, number of nodules on radiologic findings, number of metastasis, size of the metastatic nodules, type of surgery, completeness of excision, were examined. Median ages at diagnosis of primary tumor and at the first pulmonary metastasectomy were 13.2 and 14.2 years, respectively. During the study period, 110 pulmonary metastsectomies (57 VATS, 52 thoracotomies, 1 sternotomy) were performed in 60 patients. The primary tumors were osteoblastoma (n=36), Wilm’s tumor (n=5), hepatoblastoma (n=4), rhabdomyosarcoma (n=3), synovial sarcoma (n=3), Yolk sac tumor (n=2), epitheloid sarcoma (n=1), clear cell sarcoma (n=1), malignant peripheral nerve sheath tumor (n=1), Ewing’s sarcoma (n=1), mucinous adenocarcinoma (n=1), hepatocellular carcinoma (n=1), and giant cell tumor (n=1). The median follow-up after metastatic diagnosis was 10.2 years.
Results : During the follow-up, 13 patients died. Five- and 10-year survival rates were 84.9% and 73.8%, respectively. In univariate analysis, existence of extrapulmonary metastasis (p=0.010), number of resected nodules (p=0.014), number of biopsy-proven metastasis (p=0.013), and maximum size of metastatic nodule (p=0.024) were the risk factors for late mortality. However, no parameter was significantly associated with late mortality in multivariable analysis. Compared with the VATS group, the thoracotomy group showed significantly larger number of pulmonary metastasis on preoperative CT (p<0.001) and resected nodules (p<0.001), and longer time to remove chest tube (p<0.001), although there was no difference in late mortality (p=0.400).
Conclusion : Pulmonary metastasectomy in pediatric/adolescent patient demonstrated an overall 10-year survival rate of 73.8%. Appropriate patient selection should be performed before surgery, and the patient should be free of recurrent or residual disease of the primary tumor, or of extrapulmonary metastasis. Although thoracotomy metastasectomy removed a larger number of metastatic nodules than VATS metastasectomy, no difference in late mortality was observed.
책임저자: 강창현
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 김민석, Tel: 02-732-3285 , E-mail : mesmerist84@gmail.com
