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Pulmonary Metastases of Endocrine Origin : The Role of Surgery FREE TO VIEW

Junaid H. Khan; Doff B. McElhinney; Sarah B. Rahman; Tracy I. George; Orlo H. Clark; Scot H. Merrick
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Affiliations: From the Division of Cardiac Surgery, University of California San Francisco,  From the Department of Medicine, University of California San Francisco—Mount Zion Hospital, San Francisco, CA.,  From the Department of Surgery, University of California San Francisco—Mount Zion Hospital, San Francisco, CA.

Scot H. Merrick, MD, Division of Cardiac Surgery, UCSF, 505 Parnassus, M593, San Francisco, CA 94143

1998 by the American College of Chest Physicians

Chest. 1998;114(2):526-534. doi:10.1378/chest.114.2.526
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Purpose: To determine the clinical course and outcome of patients undergoing pulmonary resection for metastatic endocrine tumors.

Methods: Retrospective review of 47 patients with known endocrine tumors and pulmonary metastases who were evaluated for surgical resection between 1975 and 1996.

Results: Tumors evaluated included the following: carcinoid (16), thyroid (12), pancreatic adenocarcinoma (10), adrenocortical carcinoma (6), pheochromocytoma (2), and parathyroid (1). Thirty-three patients were asymptomatic. Hormone secretion was noted in five patients. Twenty-five patients, who had isolated lung metastases, good control of the primary tumor, and no medical contraindication had surgical resection. The number of pulmonary nodules was not a limiting factor as long as all disease could be resected with adequate residual pulmonary function. CT was successful in directing resection in all patients. Twenty-six operations were performed in 25 patients and 22 patients were treated medically. Wedge resection was performed for lesions <2 cm (15), and lobectomy for larger or multiple nodules (10). Four patients had bilateral nodules resected. There was no operative mortality and no major complications. Actuarial 5-year survival was 61% for surgically treated patients. Independent predictors of poor survival included positive mediastinal lymph nodes at time of surgery (p=0.004) and shorter disease-free interval (p=0.01). At a median of 6.7±1.2 years, six patients have developed radiographic appearance of a recurrence. A single patient with recurrent Hürthle cell cancer has had a successful reresection. The remaining patients have received chemotherapy. No patient with pancreatic carcinoma or adrenocortical carcinoma was a candidate for resection. All medically treated patients died within 6 months.

Conclusion: Patients with endocrine tumors and pulmonary metastases are usually asymptomatic, their conditions are diagnosed accurately with CT, and they can achieve long-term survival comparable to other tumors (sarcoma) after pulmonary metastasectomy.

Clinical implications: Patients with carcinoid, thyroid, pheochromocytoma, and parathyroid tumors with pulmonary metastases should undergo surgical resection if there is the following: (1) no evidence of extrathoracic disease; (2) good control of the primary tumor; (3) no medical contraindications for surgery; and (4) pulmonary function that can tolerate resection of all documented disease. The role of adjuvant chemotherapy in patients with positive lymph nodes needs further study.




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