RESUMO
Background: Patients with distant metastases have an unfavourable prognosis, but patients with isolated pulmonary metastases should generally not be considered hopeless. Complete resection of metachronous and solitary metastases leads to prolonged survival; however, the influence of the location, distribution and bilaterality of pulmonary metastases needs to be investigated further. This article aimed to investigate the role of the distribution of lung metastases in primary colorectal and renal cell cancer patients on prognosis. Methods: We retrospectively investigated the prognosis of patients with pulmonary metastases and colorectal or renal cell carcinoma, defined as the survival time of patients with different metastases. The types of metastases were unilobar, multilobar, unilateral, bilateral, diffuse, synchronous, or metachronous. The secondary outcome of this study was differences in prognosis according to additional criteria. Results: Patients with metachronous metastases had significantly greater median survival than patients with synchronous metastases. There was a statistically significant difference in median survival between patients with unilateral (better survival) and patients with bilateral (worse survival) lung metastases. In patients with renal cell carcinoma, a statistically significant difference in median survival time was detected for patients with unilateral metastases. A significantly longer median survival time was observed in patients without diffuse metastases. A significantly greater median survival time was detected in patients with no thoracic nodal involvement. Moreover, there was no statistically significant difference in the median survival time for patients with colorectal versus renal cell carcinoma in general or for those with lung metastases. No statistically significant difference in median survival time was detected for patients according to single or multiple lung metastases, additional tumours or metastases during disease, the distance of residence from a specialized clinic in Coburg, sex, smoking or adipocytes, multimorbidity, immunosuppression or different cancer treatments. Conclusions: For a minority of patients, pulmonary resection is a chance for prolonged survival. The perioperative mortality rate after metastasectomy is less than five percent. Patients with metachronous and unilateral lung metastases should be evaluated for surgery. Patients with diffuse metastases or lymph node involvement have a significantly shorter median survival time. Decision-making should be interdisciplinary.
RESUMO
Background: Treatment modalities for malignant pleural effusion (MPE) are diverse. The objectives were to analyze actual clinical data from patients with MPE and pleural carcinomatosis and to compare the outcomes of different treatment modalities with regard to effectiveness, survival, morbidity, and mortality as well as the duration of hospitalization. Methods: Patients with pathologically proven pleural carcinomatosis or MPE from 2018 to 2020 were included in this retrospective-observational study with additional questionnaires. We identified four treatment modalities: (I) video-assisted thoracic surgery with pleurodesis (VATS, mechanical/chemical); (II) VATS with pleurodesis combined with indwelling pleural catheter (IPC) placement; (III) VATS (without pleurodesis) combined with IPC placement; and (IV) management with IPC placement alone. Results: We enrolled 91 patients aged 38-90 years who were treated by either VATS-pleurodesis (N=22), VATS-IPC placement (N=21), a combination of VATS with pleurodesis and IPC placement (N=22), or IPC placement alone (N=26). The mean survival time was 138.3 days. No significant differences were detected among treatment groups regarding the outcome of pleurodesis failure, either initially or later. Patients in the VATS-pleurodesis with IPC group experienced significantly more complications than those in the other treatment modality groups [odds ratio (OR): 3.288, P=0.026]. However, no statistically significant differences were observed regarding the type of adverse event and survival. Hypoalbuminemia, systemic therapy, and successful pleurodesis (P=0.008; P=0.011; P=0.044, respectively) were significantly correlated with survival. In multiple linear regression, hypoalbuminemia persisted as an independent predictor of survival (P=0.031). The type of intervention showed significant differences regarding the duration of hospitalization (P=0.017). IPC placement alone shortened the mean total hospitalization time by 7.9, 5.9, and 7.0 days compared to VATS-pleurodesis (P≤0.001), VATS-IPC placement (P=0.004), and VATS-pleurodesis with IPC placement (P≤0.001), respectively. Conclusions: The survival time was very short, and each treatment group had pros and cons. Therefore, decisions should be made on a case-by-case basis. The use of an IPC, even if the lung is not trapped, can significantly reduce the length of hospital stay. VATS is needed when histology is needed. The ideal method for treating recurrent MPE should be simple, effective, and inexpensive, with minimal disturbance to the patient.
