METASTASIS PARU PADA KANKER KOLOREKTAL

Arief Poetranto

PENDAHULUAN
Kejadian metastasis kanker kolorektal pada paru adalah 10 30%. Sebagian besar didiagnosis 5 60 bulan setelah penanganan tumor primer. Pada umumnya secara hematogen, vena porta dan vena cava inferior. Jarang melalui limfogen Asimptomatik, dan diketemukan insidental pada pemeriksaan radiologi. Insidensi metastasis mediastinal node 3,5% 16,7%

PENDAHULUAN
Metastasectomy pertama dilakukan tahun 1885. Blalock (1944) first CRC lung metastasectomy in 1944. The International Registry of Lung Metastases study (IRLM) pembedahan merupakan tindakan efektif untuk meningkatkan survival Hanya 18% penderita kanker kolorektal dengan metastasis paru dapat menjalani metastasectomy.

PENDAHULUAN

Surgical resection of lung metastases ditentukan oleh 2 faktor esensial:

1. 2.

Resiko pembedahan Ekstensi dari metastatis

Faktor utama untuk menilai resiko operasi adalah status kardiovaskular dan status respirasi

PROGNOSTIC FACTORS

Kanemitsu and colleagues mengidentifikasi 5 prediktor dari prognosis yang buruk, yaitu:
1. 2. 3.

4.
5.

prethoracotomy CEA level number of lung metastases neoplastic involvement of hilar and mediastinallymph nodes, primary tumour histology presence of extrathoracic disease disease-free interval (DFI) the multilateral and/or synchronised nature of injuries lung tumour burden the previous stage of primary tumour liver metastases or recurrent metastases

Faktor lain yang menurunkan survival antara lain:

SURGICAL TREATMENT
The fundamental goal : to achieve a complete resection. Complete resection consistent prognostic factor 5 years survival rates 30% to 63% 10 years survival rates 18%

RESECTION CRITERIA

APPROACHES

The surgical approach must meet two requirements:

1. 2.

it should be the less aggressive as possible , allow all metastases to be resected.

APPROACHES

CRM: Cardio-Respiratory Morbidity SM: Surgical Morbidity VATS: Video-assisted Thoracoscopic Surgery

APPROACHES

CRM: Cardio-Respiratory Morbidity SM: Surgical Morbidity VATS: Video-assisted Thoracoscopic Surgery

TYPE OF REMOVAL
The purpose of this type of surgery is to achieve a complete (R0) resection while preserving the lung parenchyma as much as possible. Surgery can be divided into three basic categories: Minor resections (wedge resection and atypical) Anatomical resections (segmentectomy, lobectomy and pneumonectomy) Extended resections.

TYPE OF REMOVAL