Aggressive and minimally invasive surgery for pulmonary metastasis of sarcoma

Reza, Joseph; Sammann, Amanda; Jin, Chengshi; Horvai, Andrew E.; Hudnall, Matthew; Jablons, David M.; Jahan, Thierry; Kornak, John; Mann, Michael J.

doi:10.1016/j.jtcvs.2013.12.021

Cited by 19 publications

(12 citation statements)

References 29 publications

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“…Approximately 20%-40% of sarcoma patients develop pulmonary metastases with disease progression, often with lung as the only site. [108][109][110][111][112][113][114] Because chemotherapy historically has limited response in sarcoma patients, PM is an accepted, even preferred, treatment for patients with lung lesions. Never the less, as with other pathologies, sarcoma PM is not common.…”

Section: Sarcomamentioning

confidence: 99%

Expert Consensus Document on Pulmonary Metastasectomy

Handy

Bremner

Crocenzi

et al. 2019

The Annals of Thoracic Surgery

144

170

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When managing nonseminomatous germ cell tumors, contralateral lung abnormalities ≤ 10 mm can be observed if histology of unilateral PM demonstrates complete tumor necrosis. 17. When managing nonseminomatous germ cell tumors, PM is indicated for select patients with limited number of lung abnormalities after first or second-line platin-based chemotherapy suspected of containing viable nonseminomatous cancer and/or malignant transformation of teratoma into non-germ cell cancer. 18. In breast cancer patients, PM can be considered within a MDT construct. Pulmonary metastasectomy literature characteristics Since 1980, greater than 1000 publications addressed pulmonary metastasectomy, without a single randomized controlled trial (RCT). The overwhelming majority is surgical series, usually single institution, and includes single or multiple pathologies. The pool of patients from which metastasectomy patients derive is not reported, allowing no comparative survival analysis. Historical controls are used or metastatic disease survival is assumed to be zero, a contention not supported by the literature. Yet metastasectomy is infrequently performed (1-6.5%) when sizable populations of cancer patients are reported. [1-3] Thus surgical case series manifest inherent selection bias and do not clarify the role of metastasectomy in prolongation of survival or cure. The literature is further hampered by inconsistent or absent description of other local or systemic therapies and variable length of follow up. Finally, the literature fails to distinguish between prognostic (indolent disease which will do well with any or no treatment) or predictive

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Section: Sarcomamentioning

confidence: 99%

Expert Consensus Document on Pulmonary Metastasectomy

Handy

Bremner

Crocenzi

et al. 2019

The Annals of Thoracic Surgery

144

170

View full text Add to dashboard Cite

show abstract

“…Other Institutions, however, with the intent to provide an aggressive surgical treatment to a generally young and fit patient population, perform pulmonary resection also in patients with known extrapulmonary disease (6). While most retrospective series report unfavourable outcomes in these subjects (20,23), Blackmon and colleagues have shown that, if prior or synchronous extrathoracic disease can be completely resected, similar survival rates to those of patients with isolated lung metastases can be achieved (37.8 and 35.5 months of median survival respectively in the two groups) (6). The authors conclude that extrapulmonary metastases should no longer be viewed as an absolute contraindication for surgery.…”

Section: Extrapulmonary Diseasementioning

confidence: 99%

Survival and prognostic factors following pulmonary metastasectomy for sarcoma

Marulli¹,

Mammana²,

Comacchio³

et al. 2017

J. Thorac. Dis.

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Sarcomas are a heterogeneous group of malignancies with a marked propensity to metastasize to the lungs. Chemotherapy offers only a limited benefit in metastatic disease, whereas lung metastasectomy, in selected cases, can lead to long-term survival. Other local ablative techniques and hybrid therapies have been proposed. A multidisciplinary setting is of paramount importance for choosing the most appropriate treatment for each case. There is no randomized controlled trial providing formal evidence of the effectiveness of lung metastasectomy. Main areas of controversy concern the selection of surgical candidates, the operative approach and the role of chemotherapy. Five-year survival rates range from 15% to 50.9%, as reported mainly in retrospective case-series in which several prognostic factors were identified. In this article, the authors review the surgical management of sarcoma metastases to the lung, with a particular focus on the outcomes and prognostic factors associated with long-term survival after resection. The role of chemotherapy and other adjunctive therapies is also discussed.

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“…Elf Studien berichten, dass Patienten von einer Rezidivoperation profitieren [3-6, 8-10, 17-19, 23]. Die beobachteten 5-Jahres-Überlebensraten dieser Subgruppe mit Re-Metastasektomie waren vergleichbar mit denen der jeweiligen Gesamtkollektive [9,17,18,23]…”

Section: üBerleben Nach Lungenmetastasektomieunclassified

“…Reza et al [18] Schur et al [19] Tanju et al [20] Daw et al [21] Dossett et al [22] Okiror et al [ Resektionen sollten hierbei, wenn immer dies möglich erscheint, vorgezogen werden. Die Selektion der Patienten, die von einer Metastasektomie profitieren können, stellt eine Herausforderung dar.…”

Section: Prognosefaktoren (Auf Basis Multivariater Analysen)unclassified

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Lungenmetastasenchirurgie bei Patienten mit fortgeschrittenen Weichteil- und Osteosarkomen

et al. 2017

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Advanced soft tissue or osteosarcoma is often associated with lung metastases. Curative pulmonary metastasectomy is appropriate for patients with successfully resected primary cancer who show no evidence of extrapulmonary metastases, with proven functional operability and completely resectable metastases. Systematic literature research and qualitative analysis of studies on patients undergoing lung metastasectomy after resection of primary sarcoma published since 01.01.2010. We assessed operative findings, survival data and prognostic factors. Pulmonary metastasectomy results in a median postmetastasectomy survival of 8.76 to 69.9 months. Five year survival rates after metastasectomy vary between 21.7 and 56.8%. The patients' prognosis depends particularly on complete resection of all suspected metastases. Intrapulmonary recurrence could be treated by repeated resection, but this procedure requires careful decision for indication. Re-metastasectomy might result in a favourable outcome in selected cases. Pulmonary metastasectomy should be considered as treatment of choice in selected patients with isolated lung metastases from osteosarcoma. Optimal indication might lead to an advantage in patients with metastasectomy of isolated lung metastases from soft tissue.

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Aggressive and minimally invasive surgery for pulmonary metastasis of sarcoma

Abstract: Evolving surgical practice may allow an increasingly aggressive approach to pulmonary sarcoma metastasis, which may be facilitated by increased use of a minimally invasive approach.

Cited by 19 publications

References 29 publications

Expert Consensus Document on Pulmonary Metastasectomy

Expert Consensus Document on Pulmonary Metastasectomy

Survival and prognostic factors following pulmonary metastasectomy for sarcoma

Lungenmetastasenchirurgie bei Patienten mit fortgeschrittenen Weichteil- und Osteosarkomen

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