Evaluation of video-assisted thoracoscopic surgery for pulmonary metastases: 11-years of experience

Saisho, Shinsuke; Nakata, Masao; Shibata, Shigeki; Yamashita, Motohiro; Saya, Hideyuki; Kurita, Akira; Takashima, Shigemitsu

doi:10.1007/s00464-008-9895-y

Cited by 26 publications

(19 citation statements)

References 28 publications

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“…They are unlikely to add further knowledge 59,60 and yet they continue to appear in the surgical literature. [61][62][63] There are circumstances where the immediacy of cause and effect, the mechanistically obvious relationship between intervention and benefit, and the large and incontrovertible effect leads us to accept a treatment because we can see that it works. 64 In the practice of pulmonary metastasectomy in colorectal cancer, these conditions do not prevail.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary metastasectomy in colorectal cancer: a systematic review and quantitative synthesis

et al. 2010

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SummaryObjectives Surgical removal of pulmonary metastases from colorectal cancer is undertaken increasingly but the practice is variable. There have been no randomized trials of effectiveness. We needed evidence from a systematic review to plan a randomized controlled trial.Design A formal search for all studies concerning the practice of pulmonary metastasectomy was undertaken including all published articles using pre-specified keywords. Abstracts were screened, reviewed and data extracted by at least two of the authors. Information across studies was collated in a quantitative synthesis. ResultsOf 101 articles identified, 51 contained sufficient quantitative information to be included in the synthesis. The reports were published between 1971 and 2007, and reported on 3504 patients. There was little change over time in patient characteristics such as age, sex, the time elapsed since resection of the primary cancer, its site or stage. The proportion with multiple metastases or elevated carcinoma embryonic antigen (CEA) did not change over time but there was an apparent increase in the proportion of patients who also had hepatic metastasectomy. Differences in 5-year survival between groups defined by CEA or by single versus multiple metastases persisted over time. Few data were available concerning postoperative morbidity, postoperative lung function or change in symptoms. ConclusionThe quality of evidence available concerning pulmonary metastasectomy in colorectal cancer is not sufficient to draw inferences concerning the effectiveness of this surgery. There is great variety in what was reported and its utility. Given the burdensome nature of the surgery involved, better evidence, ideally in the form of a randomized trial, is required for the continuance of this practice.

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Section: Discussionmentioning

confidence: 99%

Pulmonary metastasectomy in colorectal cancer: a systematic review and quantitative synthesis

et al. 2010

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“…Recent years have seen increased application of VATS, allowing less invasive pulmonary resection as compared to conventional open-chest surgery. VATS is now performed at many institutions, and its usefulness has been documented [5,6]. …”

Section: Discussionmentioning

confidence: 99%

Role of treatment for solitary pulmonary nodule in breast cancer patients

et al. 2011

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BackgroundMetastatic pulmonary tumors secondary to breast cancer detected either before or after surgery are predominantly multiple and bilateral. However, in cases detected to have a solitary pulmonary nodule (SPN), determining whether the lesion represents a primary cancer, metastasis, or a benign pulmonary lesion can be difficult.Materials and methodsBetween January 2000 and December 2009, we performed breast cancer surgery on 1,226 patients, of which 49 cases (3.9%) were detected to have pulmonary lesions before or after the surgery. In 14 of these patients, video-assisted thoracoscopic surgery was performed to remove a SPN.ResultPathological examination of the resected specimens in these 14 cases revealed metastatic pulmonary tumor in 8 cases, primary lung cancer in 3 cases, and benign disease in 3 cases. While lobectomy was performed in one of these patients with metastatic pulmonary tumor, the remaining 7 underwent partial resection of the lung. The primary lung cancer was an adenocarcinoma in all 3 patients, and lobectomy plus mediastinal lymph node dissection was performed in these patients. The tumor grading based on pathological diagnosis was T1N0M0, p-Stage 1A in all 3 patients. The prognosis was good in the breast cancer patients in whom the metastatic lung tumor was a SPN.ConclusionEvaluating the immunohistochemical cytokeratin profile and levels of the TTF-1 and GCDFP-15 of the lesion was useful when distinguishing between pulmonary cancer and metastatic pulmonary tumor. In addition, some patients exhibited changes in the biological properties of the metastatic tumor, and delete tumor resection by video-assisted thoracoscopic surgery can be useful for deciding the drug treatment strategy in some cases

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“…Cancer recurrence at VATS port sites has not been widely reported: a single study reports 38 four recurrences in 26 cases, with all recurrences occurring within the first 5 postoperative months. A second study 39 reports three port site recurrences in 36 cases. These reports encompass results from early VATS procedures -increasing use of wound protectors and specimen extraction bags 37 has reduced this risk significantly.…”

Section: Choice Of Incision and Approachmentioning

confidence: 98%

Surgical Management of Colorectal Lung Metastasis

Villeneuve

Sundaresan²

2009

Clinics in Colon and Rectal Surgery

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Colon cancer is a systemic disease in 19% of patients and metastasizes most frequently to the liver and the lung. Survival is enhanced with complete surgical resection of pulmonary metastases. Comprehensive restaging and verification of preoperative fitness must precede resection. The operative approach is dictated by the anatomic location of the metastases, whereas the extent of resection remains a balance between complete removal of metastatic deposits while preserving as much lung parenchyma as possible. The presence of metastatic involvement of hilar and mediastinal lymph nodes is ominous. Multidisciplinary care is highly recommended. An evidence-based algorithm for the identification assessment and treatment of patients with pulmonary metastases is proposed. KEYWORDS: Pulmonary metastases, colorectal cancer, surgical management, outcomesObjectives: On completion of this article, the reader should have an appreciation for the role of metastasectomy for pulmonary metastases from colorectal cancer, understand the importance of restaging and preoperative cardiopulmonary assessment, and apply the algorithm for identification and referral of patients for consideration of metastasectomy. METASTATIC COLORECTAL CANCERColorectal cancer (CRC) is an extremely prevalent cancer, with greater than 1 million cases identified in the world yearly. Of these cases, 19% present with stage IV disease. Colorectal cancer metastases are most commonly found in the liver; lung is the second most common site. Overall survival with untreated stage IV disease is 11.3% at 5 years, 1 although in a selected patient population, resection of isolated pulmonary metastases can increase survival rates up to 40% at 5 years. 2,3 HISTORICAL ASPECTS AND RATIONALE FOR PULMONARY METASTASECTOMY The first reported case of pulmonary metastasectomy dates back to 1882, when Weinlechner performed pulmonary resection for two incidental lesions found during resection of a sarcomatous chest wall lesion. 4 This was followed by a planned resection of pulmonary metastases by Divis 5 in 1927. Long-term survival was observed in 1934, as Edwards 6 reported 18-year survival after resection of metastatic osteogenic sarcoma. Barney and Churchill 7 then reported 23-year survival after resection

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Evaluation of video-assisted thoracoscopic surgery for pulmonary metastases: 11-years of experience

Abstract: VATS for pulmonary metastases is not superior to the conventional open thoracotomy and is not recommended as a standard procedure. Further studies with a larger number of cases performed by skilled surgeons familiar with VATS are needed.

Cited by 26 publications

References 28 publications

Pulmonary metastasectomy in colorectal cancer: a systematic review and quantitative synthesis

Pulmonary metastasectomy in colorectal cancer: a systematic review and quantitative synthesis

Role of treatment for solitary pulmonary nodule in breast cancer patients

Surgical Management of Colorectal Lung Metastasis

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