Traditionally the finding of pulmonary metastasis was synonymous with therapeutic give up and short dated condemnation. But, the first pulmonary resection for metastatic carcinoma was performed by Barney and Churchill in 1939 when a lobectomy
carried
out for a solitary lesion proved to be metastatic renal cell carcinoma. Since then pulmonary resection of metastatic lesions was performed in many centers, and they reported good survival rates. This study was based on 852 patients of
gastrointestinal
cancer who was adimitted to Chun Chon Sacred Heart Hospital during the period of March 1985 to December 1992, pulmonary metastesis was present in 21 patients (2.5%). The diagnostic methods for pulmonary metasis were chest roentgeno-graphy and
computed
tomography, and were performed CT-guided fine needle biopsy of bronchoscopic biopsy in the doubtful cases.
@ES The results were as follows
@EN 1) The age distribution was from 29 years to 77 years with an average age of 58.6 years, and male to female ratio was 0.9:1.
2) The origins of cancers ; The gastric cancer was 10 cases in 683 cases (1.4%), the colon cancer was 4 cases in 95 cases (4.2%), and rectal cancer was 7 cases in 74 cases (4.2%).
3) In chest roentgenogram, one metastatic nodule was noted 7 cases (33.3%), and multiple nodules were noted in 14 cases of 21 cases (66.6%).
4) The sites of metastatic nodules ; In 7 single nodules, 5 cases were located in the left lobe (23.8%) and 2 cases in the right lobe (9.5). The both lobes were involved in 14 cases of the multiple nodules (66.7%).
5) The mean size of nodules was 21. cm (1.0~3.3cm) in 7 cases of single nodule, and variable sized nodules (0.5cm~50cm) were noted in 14 cases of multiple metastatic nodules.
6) The stages of primary cancers ; In the gastric cancer, one case was stage III and 9 cases were stage IV (INM classification). In colorectal cancer, each one case was stage B1 and B2. Two cases were Cl, and 4 cases were C2 in colorectal cancer
(Duke's classification).
7) The mean survival duration after pulmonary metastasis was 14.9 months ( 1 to 45 months) in single nodule and 2.8 months (1 to 7 months) in multiple nodules.
8) The mean duration of desease free interval after curative resection of primary cancer was 33.7 months (1~96 months), and mean survival time after pulmonary metastasis was 6.7 months (0~22 months) in operable 12 cases that no metastatic site.
The
mean survival time was 4.1 months (1~16 months) in inoperable 7 cases because of pulmonary metastasis.
9) The mean survival time after pulmonary metastasis was 6.7 months (1 to 45 months) in stomach cancer and 8.7 months (1 to 22 months) in colorectal cancer.
A review of 21 patients who had pulmonary metastases from gastrointestinal cancer was presented. In summary, pulmonary metastases were significantly more common at 6th decades female and in left lung, and they had almost multiple or advanced
disease at
the time of diagnosis. On the basis of this study, we can assume that pulmonary resection could be carried out in case of single pulmonary metastatic nodule for extention of survival length. Follow up studies should be carred out at 3~6 month
intervals
after control of primary cancer, depending on the tumor histology.
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