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Evolução da terapêutica cirúrgica das metástases pulmonares
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As metástases pulmonares são tumores malignos secundários que se vão localizar no parênquima pulmonar, afetando cerca de 30% dos doentes com cancro. A necessidade de um tratamento eficaz é grande, e desde há mais de 100 anos que se começaram a realizar cirurgias para resseção das metástases, sendo a metastasectomia atualmente bastante aceite e globalmente realizada. Grandes controvérsias relativamente a qual a melhor abordagem, aberta versus minimamente invasiva, continuam a existir, mas começa a haver uma preferência pela minimamente invasiva, justificando-se com a evolução de técnicas de imagem que compensam a necessidade de palpação manual para identificação de nódulos que eram previamente ignorados nas técnicas de imagem mais primitivas. Coloca-se também em questão a realização de resseções repetidas nos casos de recidivas. Para alguns tipos histológicos parece haver benefício. Por último, o prognóstico parece ser influenciado por vários fatores, sendo o mais aceite globalmente a realização de uma resseção completa (R0). Outros fatores referidos são o DFI, o tamanho e número das lesões metastáticas e o envolvimento de nódulos linfáticos. Os fatores podem variar de acordo com o tipo de tumor primário, sendo ele próprio um condicionante do prognóstico.
Pulmonary metastases are secondary malignant tumors that are localized in the lung parenchyma, affecting approximately 30% of cancer patients. Consequently, there is a need for effective treatment and over 100 years ago, surgeries for metastasis resection began to be performed, with metastasectomy currently being widely accepted and globally practiced. There are major controversies regarding the best approach, open surgery versus minimally invasive, but there is a growing preference for minimally invasive procedures, justified by the advancement of imaging techniques that compensate for the need for manual palpation to identify nodules that were previously overlooked in more primitive imaging techniques. The repetition of resections in cases of recurrence is also questioned. There seems to be a benefit for certain histological types. Lastly, prognosis appears to be influenced by various factors, with complete resection (R0) being globally accepted as the most influential. Other factors mentioned include disease-free interval (DFI), size and number of metastatic lesions, and involvement of lymph nodes. These factors can vary depending on the type of primary tumor, which itself is a prognostic determinant.
Pulmonary metastases are secondary malignant tumors that are localized in the lung parenchyma, affecting approximately 30% of cancer patients. Consequently, there is a need for effective treatment and over 100 years ago, surgeries for metastasis resection began to be performed, with metastasectomy currently being widely accepted and globally practiced. There are major controversies regarding the best approach, open surgery versus minimally invasive, but there is a growing preference for minimally invasive procedures, justified by the advancement of imaging techniques that compensate for the need for manual palpation to identify nodules that were previously overlooked in more primitive imaging techniques. The repetition of resections in cases of recurrence is also questioned. There seems to be a benefit for certain histological types. Lastly, prognosis appears to be influenced by various factors, with complete resection (R0) being globally accepted as the most influential. Other factors mentioned include disease-free interval (DFI), size and number of metastatic lesions, and involvement of lymph nodes. These factors can vary depending on the type of primary tumor, which itself is a prognostic determinant.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Metástases pulmonares Metastasectomia Resseção cirúrgica Oncologia