The Role of Primary Tumor Resection in Patients with Pleural Metastasis Encountered at the Time of Surgery

Background@#Evidence is lacking on whether the resection of lung parenchymal cancer improves the survival of patients with unexpected pleural metastasis encountered during surgery. We conducted a single-center retrospective study to determine the role of lung resection in the long-term survival of these patients. @*Methods@#Among 4683 patients who underwent lung surgery between 1995 and 2014, 132 (2.8%) had pleural metastasis. After excluding 2 patients who had incomplete medical records, 130 patients’ data were collected. Only a diagnostic pleural and/or lung biopsy was performed in 90 patients, while the lung parenchymal mass was resected in 40 patients. @*Results@#The mean follow-up duration was 29.8 months. The 5-year survival rate of the resection group (34.7%±9.4%) was superior to that of the biopsy group (15.9%±4.3%, p=0.016). Multivariate Cox regression analysis demonstrated that primary tumor resection (p=0.041), systemic treatment (p<0.001), lower clinical N stage (p=0.018), and adenocarcinoma histology (p=0.009) were significant predictors of a favorable outcome. Interestingly, primary tumor resection only played a significant prognostic role in patients who received systemic treatment. @*Conclusion@#When pleural metastasis is unexpectedly encountered during surgical exploration, resection in conjunction with systemic treatment may improve long-term survival, especially in adenocarcinoma patients without lymph node metastasis.

Functional Intracardiac Paraganglioma

A 39-year-old man presented to the department of emergency medicine in Seoul National University Hospital complaining of chest pain, heart palpitation, and headache. Upon arrival, a computed tomography scan showed a 7.0 cm×6.2 cm lesion with the typical features of a paraganglioma. The patient was treated with an alpha-blocker and a beta-blocker prior to surgical intervention. We removed the tumor successfully, and histopathologic findings indicated that the tumor was indeed a paraganglioma. Since intracardiac paraganglioma is a rare disease, we present this case together with a literature review.