Öz
Amaç: Çocukluk çağı solid
tümörlerinin akciğer metastazlarında kliniğimizin cerrahi yaklaşımının
değerlendirilmesidir.
Olgular ve Yöntem: Akciğer metastazı nedeniyle 1978-2016 arasında başvuran ve cerrahi
girişim yapılan olgular geriye dönük olarak incelendi. Yaş, cinsiyet, primer
tanı, akciğer metastazının ortaya çıkış zamanı, cerrahi tedavi yöntemi,
patolojik tanı ve takip açısından değerlendirme yapıldı. Primer tümörü kontrol
altına alınan, başka uzak organ metastazı olmayan ve akciğer metastazı için
cerrahi tedavi uygulanan olgular çalışmaya alındı.
Bulgular: Onsekiz olgunun (K/E:11/7)
yaş ortalaması 8,1 yıl (1,5-14 yaş) idi. Primer tümörler; Wilms tümörü
(n:9,%50), Ewing sarkomu (n:3,%17), osteosarkom (n:2,%11), hepatoblastom
(n:1,%5,5), fibrosarkom (n:1,%5,5), rabdomyosarkom (n:1,%5,5) ve endodermal
sinüs tümörü (n:1,%5,5) idi. Olguların 4’ünde ilk başvuru anında akciğer
metastazı mevcuttu. Onaltısında metastazın ortaya çıkış zamanı ortalama 16, 5
ay (7ay-4 yıl) idi. Radyolojik değerlendirme tüm olgularda preoperatif dönemde
akciğer grafisi ve bilgisayarlı tomografi (BT) ile yapıldı. Onsekiz olguya
toplam 23 torakotomi yapıldı. Yirmibir wedge rezeksiyon, 1 lobektomi, 1
lobektomi ve kot rezeksiyonu uygulandı. Patolojik incelemede çıkarılan
lezyonların 3’ü inflamatuar reaksiyon olarak değerlendirildi. Toraks dreni
alınma süresi ortalama 5,2 gün(3-8), hastanede kalış süresi 7,3 gün(5-10 gün)
idi. Cerrahi girişime bağlı komplikasyon görülmedi. Takipte 6 olgu ilerleyici
primer hastalık nedeniyle kaybedildi.
Sonuç: Çocukluk çağı tümörlerinde
akciğer metastazları başvuru sırasında ve/veya takipte görülebilir. Cerrahi
tedavisinde sınırlı rezeksiyon yeterli görünmektedir. Torakotomi bu olgularda
tüm lezyonların değerlendirilmesini sağlamaktadır ve güvenle uygulanmaktadır.
Radyolojik incelemeler tümör metastazını desteklese de kesin tanı patolojik
inceleme ile konulmaktadır.
Anahtar Kelimeler
Kaynakça
- 1: Abel RM, Brown J, Moreland B, Parikh D. Pulmonary metastasectomy for pediatric solid tumors. Pediatr Surg Int. 2004 Aug;20(8):630-2. 2: Soyer T. Çocuklarda akciğer metastazektomi ilkeleri. Çocuk Cerrahisi Dergisi. 30(5):520-523,2016 3: Erginel B, Gun Soysal F, Keskin E, Kebudi R, Celik A, Salman T. Pulmonary metastasectomy in pediatric patients. World J Surg Oncol. 2016 Feb 2;14(1):27. 4: Bhattasali O, Vo AT, Roth M, Geller D, Randall RL, Gorlick R, Gill J. Variability in the reported management of pulmonary metastases in osteosarcoma. Cancer Med. 2015 Apr;4(4):523-31. 5: Kayton ML. Pulmonary metastasectomy in pediatric patients. Thorac Surg Clin. 2006 May;16(2):167-83 6: Fuchs J, Seitz G, Handgretinger R, Schäfer J, Warmann SW. Surgical treatment of lung metastases in patients with embryonal pediatric solid tumors: an update. Semin Pediatr Surg. 2012 Feb;21(1):79-87. 7: Kaste SC, Pratt CB, Cain AM, Jones-Wallace DJ, Rao BN. Metastases detected at the time of diagnosis of primary pediatric extremity osteosarcoma at diagnosis: imaging features. Cancer. 1999 Oct 15;86(8):1602-8. 8: Heaton TE, Hammond WJ, Farber BA, Pallos V, Meyers PA, Chou AJ, Price AP, LaQuaglia MP. A 20-year retrospective analysis of CT-based pre-operative identification of pulmonary metastases in patients with osteosarcoma: A single-center review. J Pediatr Surg. 2017 Jan;52(1):115-119. 9: Tronc F, Conter C, Marec-Berard P, Bossard N, Remontet L, Orsini A, Gamondes JP, Louis D. Prognostic factors and long-term results of pulmonary metastasectomy for pediatric histologies. Eur J Cardiothorac Surg. 2008 Dec;34(6):1240-6. 10: Letourneau PA, Xiao L, Harting MT, Lally KP, Cox CS Jr, Andrassy RJ, Hayes-Jordan AA. Location of pulmonary metastasis in pediatric osteosarcoma is predictive of outcome. J Pediatr Surg. 2011 Jul;46(7):1333-7 11: Karnak I, Emin Senocak M, Kutluk T, Tanyel FC, Büyükpamukçu N. Pulmonary metastases in children: an analysis of surgical spectrum. Eur J Pediatr Surg. 2002 Jun;12(3):151-8. 12: Fuchs J, Seitz G, Ellerkamp V, Dietz K, Bosk A, Müller I, Warmann SW, Schäfer JF. Analysis of sternotomy as treatment option for the resection of bilateral pulmonary metastases in pediatric solid tumors. Surg Oncol. 2008 Dec;17(4):323-30. 13: Heaton TE, Davidoff AM. Surgical treatment of pulmonary metastases in pediatric solid tumors. Semin Pediatr Surg. 2016 Oct;25(5):311-317. 14: Denbo JW, Zhu L, Srivastava D, Stokes DC, Srinivasan S, Hudson MM, Ness KK, Robison LL, Neel M, Rao B, Navid F, Davidoff AM, Green DM. Long-term pulmonary function after metastasectomy for childhood osteosarcoma: a report from the St Jude lifetime cohort study. J Am Coll Surg. 2014 Aug;219(2):265-71.
Öz
Aim: To evaluate our surgical
approach to lung metastasis of childhood tumors.
Patients and method: Cases with solid tumor
lung metastasis that underwent surgical intervention between years 1978-2016
were investigated retrospectively. Patients were evaluated regarding age,
gender, primary diagnosis, time of lung metastasis occurence, surgical
treatment method, pathological diagnosis and follow-up.
Results: Of the 18 cases which were
operated due to lung metastasis 11 were female, 7 were male. Median age was 8,1
years (range 1,5-14 years). The most common pulmonary
metastasis were related to Wilms' tumor(n:9). Lung metastasis were present at the
initial diagnosis in 4 patients. In the remaining 14 patients, the average time
of occurence of metastasis was 16,5 months ( range 7 mo-4yr). In all cases the
CT imaging demonstrated findings compatible with lung metastasis. Twenty-three thoracotomies were performed in eighteen cases. Surgical procedures were;
wedge resection in 21, lobectomy in 1 and lobectomy with costal bone resection
in another. Pathological diagnosis was negative for tumor metastasis in 3
patients who had CT imaging indicative of the disease. Average time of chest
tube removal was 5,2 days (range 3-8 ) while average length of hospital stay
was 7,3 days (range 5-10 days). During follow-up, 6 cases died due to
progressive primary disease.
Conclusion: In patients with childhood
tumors, lung metastasis can be encountered at initial diagnosis and/or during
follow-up. From the surgical point of view, limited resection is considered to
be adequate. Although radiological imaging supports tumor metastasis,
definitive diagnosis should be made via pathological evaluation.
Anahtar Kelimeler
Kaynakça
- 1: Abel RM, Brown J, Moreland B, Parikh D. Pulmonary metastasectomy for pediatric solid tumors. Pediatr Surg Int. 2004 Aug;20(8):630-2. 2: Soyer T. Çocuklarda akciğer metastazektomi ilkeleri. Çocuk Cerrahisi Dergisi. 30(5):520-523,2016 3: Erginel B, Gun Soysal F, Keskin E, Kebudi R, Celik A, Salman T. Pulmonary metastasectomy in pediatric patients. World J Surg Oncol. 2016 Feb 2;14(1):27. 4: Bhattasali O, Vo AT, Roth M, Geller D, Randall RL, Gorlick R, Gill J. Variability in the reported management of pulmonary metastases in osteosarcoma. Cancer Med. 2015 Apr;4(4):523-31. 5: Kayton ML. Pulmonary metastasectomy in pediatric patients. Thorac Surg Clin. 2006 May;16(2):167-83 6: Fuchs J, Seitz G, Handgretinger R, Schäfer J, Warmann SW. Surgical treatment of lung metastases in patients with embryonal pediatric solid tumors: an update. Semin Pediatr Surg. 2012 Feb;21(1):79-87. 7: Kaste SC, Pratt CB, Cain AM, Jones-Wallace DJ, Rao BN. Metastases detected at the time of diagnosis of primary pediatric extremity osteosarcoma at diagnosis: imaging features. Cancer. 1999 Oct 15;86(8):1602-8. 8: Heaton TE, Hammond WJ, Farber BA, Pallos V, Meyers PA, Chou AJ, Price AP, LaQuaglia MP. A 20-year retrospective analysis of CT-based pre-operative identification of pulmonary metastases in patients with osteosarcoma: A single-center review. J Pediatr Surg. 2017 Jan;52(1):115-119. 9: Tronc F, Conter C, Marec-Berard P, Bossard N, Remontet L, Orsini A, Gamondes JP, Louis D. Prognostic factors and long-term results of pulmonary metastasectomy for pediatric histologies. Eur J Cardiothorac Surg. 2008 Dec;34(6):1240-6. 10: Letourneau PA, Xiao L, Harting MT, Lally KP, Cox CS Jr, Andrassy RJ, Hayes-Jordan AA. Location of pulmonary metastasis in pediatric osteosarcoma is predictive of outcome. J Pediatr Surg. 2011 Jul;46(7):1333-7 11: Karnak I, Emin Senocak M, Kutluk T, Tanyel FC, Büyükpamukçu N. Pulmonary metastases in children: an analysis of surgical spectrum. Eur J Pediatr Surg. 2002 Jun;12(3):151-8. 12: Fuchs J, Seitz G, Ellerkamp V, Dietz K, Bosk A, Müller I, Warmann SW, Schäfer JF. Analysis of sternotomy as treatment option for the resection of bilateral pulmonary metastases in pediatric solid tumors. Surg Oncol. 2008 Dec;17(4):323-30. 13: Heaton TE, Davidoff AM. Surgical treatment of pulmonary metastases in pediatric solid tumors. Semin Pediatr Surg. 2016 Oct;25(5):311-317. 14: Denbo JW, Zhu L, Srivastava D, Stokes DC, Srinivasan S, Hudson MM, Ness KK, Robison LL, Neel M, Rao B, Navid F, Davidoff AM, Green DM. Long-term pulmonary function after metastasectomy for childhood osteosarcoma: a report from the St Jude lifetime cohort study. J Am Coll Surg. 2014 Aug;219(2):265-71.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 6 Aralık 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 48 Sayı: 4 |
