Surgical Approach to

Pulmonary Metastases
from Breast Cancer
Pembimbing:
dr. Ahmad Kurnia, Sp. B(K)Onk
Dr. Yopi, Sp.B

Dr. Primayudha
 Surgical Approach to
Pulmonary Metastases from
Breast Cancer

Witold Kycler, PhD, and Piotr Laski, PhD

Department of Oncological Surgery II, Great
Poland Cancer Centre, Poznan, Poland
Breast Cancer is the commonest cancer in woman and the
commonest cause of cancer related death

The vast majority of cancer related death are due to

metastasis

In a series at Mayo clinic shown that from 60 patients who

suffered from isolated pulmonary metastases, only 40
patients underwent complete resection
 Materials and Methods
Woman with isolated pulmonary metastases who underwent
pulmonary resection

Inclusion criteria:
Controlled primary tumor
No disease is evident outside the lung (determined by physical
examination, abdominal ultrasound, and bone radionuclide
scanning)
CT scan shows complete resection is possible
Patients at good operative risk
Chemotherapy has been exhausted or there was no response

Lung metastases were detected by X-rays along with CT scan

 Materials and Methods
Receptors

20

15

10 Series 1

0
Estrogen (+) Estrogen (+) Estrogen (-)
Progesteron (+) Progesteron (-) Progesteron (-)
 Material and Methods
Grading

18
16
14
12
10 Grading
8
6
4
2
0
Grade 1 Grade 2 Grade 3
Elston Ellis modification of Scarf-Bloom-
Richardson grading System

Glandular (Acinar)/tubular Differentiation

Score 1: >75% of tumor area forming glandular/tubular
structurees
Score 2: 10% to 75% of tumor area forming glandular/tubular
structures
Score 3: <10% of tumor area forming glandular/tubular
structures
Material and Methods
Past Operation

Mastectomy with
lymph node dissection
Tumorectomy with
lymph node dissection
 Material and Methods
Locoreegional treatment by radiotherapy associated with
surgery was given to 77% of patients

Adjuvant Chemotherapy was administered in 91% of

patients

Adjuvant Hormonotherapy was given to 39% of patients

30% of patients received both Chemotherapy and

Hormonotherapy

30 Patients have received chemotherapy, 3 patients have no

response with chemotherapy
 Material and Methods
Posterolateral Thoracotomy was done in all patients

The writer assesed :

Disease free interval (DFI),i.e., time between primary breast
cancer surgery and the diagnosis of lung metastases
The survival after lung mastectomy
The number of location (one or both sides) of lung metastases
The diameter in mm of metastases and the extent of pulmonary
resection
Perioperative complications
 Material and Methods
The median observation time was 71.30 months

CT scan was performed to detect newly appearing

pulmonary metastases or recurrence of the breast carcinoma

Extrapulmonary spread was detected by physical

examination, abdominal ultrasound, and in some cases using
bone radionuclide scanning

Observation time ended on 15 december 2007

 Material and Methods
Survival probability was estimated by use of the Kaplan-
Meier method

Data of statistical significance of prognostic factors for

survival time in univariate analysis was assesed by the log
rank test

Prognostic factors were matched in a multivariate analysis,

using cox regression models.

A probability value of p < 0.05 was considered statistically

significant for all procedure
 Result
Between January 1994 and December 2002 among 33
patients, 43 pulmonary resections were performed for lung
metastases from breast cancer

Average age was 53.4 with a range of 33-75 years

Mean 5-year survival rate of the group was 54,5%

Mean 3-year survival rate of the group was 81,8%

Mean 2-year survival rate of the group was 87,9%

 Result
The Author divided the group into two groups with DFI >36
months and lower

There was a statistically significant difference in survival

times with better prognosis for patients with DFI >36
months

The average time interval (DFI) between primary breast

cancer and the diagnosis of the lung metastases was 51.9
months
 number of masses resected
16
14
12
10
8
number of masses
6 resected
4
2
0
solitary 2 3 4 5 6
mass masses masses masses masses masses
 Results
In our study we found a significant survival benefit (p =
0.0275) for patients with complete resection

There was significant difference between complete resection

and incomplete resection without safety margin (p=0.0153)

Patients who underwent multiple operations tended to show

worse prognosis (p=0,0211)
 Discussion
Because of the small number of breast cancer patients who
are candidates for pulmonary metastasectomy, a prospective,
randomized trial is hard to conduct and the usefulness of this
method of treatment may not be accepted by all physicians.

Survival following surgery in patients with poor prognostic

indicators is still superior to that of those after any other
form of treatment without surgery
 Conclusion
Resection of lung metastases from breast cancer may offer a
significant survival benefit for selected patients

Prognosic factors for survival after metastasectomy are DFI

longer than 36 months and complete resection of metastases

Lung metastasectomy by conventional surgery is a safe

procedure with low perioperative morbidity
Thank You