Migration of a Kirschner wire from the clavicle into the intrathoracic trachea.

We report a 70-year-old man who had a rare complication related to the insertion of Kirschner wires for fixation of a right clavicle fracture. Eight months after the placement of the Kirschner wires, he presented with cough and hemosputum. Chest roentgenograms, chest computed tomographic scans, and bronchoscopy revealed that one of the Kirschner wires had migrated through the lung and into the intrathoracic trachea. Immediate thoracotomy was performed to remove the wire. His postoperative course was uneventful.

[Prognosis of patients undergoing resection of both hepatic and pulmonary metastases from colorectal cancer].

This retrospective study evaluated the prognosis of patients undergoing resection of both hepatic and pulmonary metastases from colorectal cancer. The subjects were 14 patients who underwent resection of both hepatic and pulmonary metastases from colorectal cancer between January 1991 and January 2008. The range of patient age at first metastatectomy was 48- 73-years-old (median 59). The ratio of males to females was 4 to 3. Hepatic metastatectomy proceeded to pulmonary metastatectomy in 10 cases, while pulmonary metastatectomy was performed first in 4 cases. The median duration of relapse-free survival and overall survival after the second metastatectomy was 11.2 months and 20.4 months, respectively. The overall survival after the second metastatectomy tended to correlate with the relapse-free survival after the first metastatectomy (rs=0.55, p=0.08). In conclusion, relapse-free survival after the first metastatectomy should be considered when a second metastatectomy is scheduled in patients with both hepatic and pulmonary metastases from colorectal cancer.

[Problems involved in the resection of pulmonary metastasis from colorectal cancer in the era of new anticancer drugs].

BACKGROUND AND PURPOSE: Surgical resection has been the standard treatment recommended for respectable pulmonary metastasis from colorectal cancer. However, we should evaluate again the indication of bilateral thoracotomy and repeat resection of pulmonary metastatic lesions, because these surgical interventions may deteriorate the patients' quality of life. This retrospective study was performed to address this issue. PATIENTS AND METHODS: The subjects were 39 patients who underwent pulmonary metastatectomy of colorectal cancer between May 1990 and January 2007. The prognosis was evaluated according to the types of thoracotomy, bilateral thoracotomy (n=5), repeat pulmonectomy (n=6), and single thoracotomy (n=28). In addition, the impact of new anticancer drugs (5-fluorouracil+Leucovorin, S-1, irinotecan, and oxaliplatin) on survival after thoracotomy was examined. RESULTS: The patients undergoing bilateral thoracotomy showed a significantly shorter survival after the last thoracotomy than those in other groups (p=0.03). The survival time after the initial thoracotomy was not different between patients who received new anticancer drugs (n=11) and those without (n=28, p=0.58). CONCLUSIONS: Bilateral pulmonary metastatectomy from colorectal cancer appears to have little benefit on survival, while a repeat metastatectomy may cause a long-term survival. A further collection of cases is needed to conclude whether the new anticancer drugs would be useful for prolonging the patients' survival after pulmonary metastatectomy.