Extending Surgery for Pulmonary Metastasectomy: What Are the Limits?

Jakovic, Radoslav; Hensens, Ab G.; Klepetko, Walter

doi:10.1097/jto.0b013e3181dcf7b1

Cited by 37 publications

(16 citation statements)

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“…Because most of our cases have a large metastases (mean size is above 4 cm) the diagnostic accuracy has been high [12]. Moreover, the preoperative diagnosis of large mass (Figure 1) suspected for LM is of paramount importance as extended operations for LM have been reported with poor outcome [13]. We performed open surgical resection as in absence of proved advantage of one open versus VATS metastasectomy [4,14], we prefer to palpate all the lung to search for extra nodules.…”

Section: Discussionmentioning

confidence: 99%

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

et al. 2015

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Aim: As part of the Catania symposium on lung metastasectomy we reviewed our practice of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of pulmonary metastatic lesions with particular emphasis on diagnostic accuracy and nature of complications lesions. materials & methods: 25 patients with metastatic lesions of the lung have been evaluated between May 2010 and February 2014. Inclusion criteria consisted of patients with histologically confirmed, metastatic disease of the lung, those receiving a CT-guided needle biopsy, were at least 18 years of age; and with adequate hepatic, renal and hematological function. We recorded also the size of the sampled lesions, their distance from the pleura, the complications encountered (pneumothorax and thoracostomy tube placement), the cytological diagnosis and the outcome in all the cases. Results: CT-guided percutaneous transthoracic needle biopsy were performed on 23 of 25 patients with suspected lung metastases. 17 males and six females with a mean age of 71.4 years. The mean size of lesions was 4.2 cm (range: 1 to 17 cm). For CT-guided needle biopsy, an 18 gauge semi-automatic needle biopsy device was used. Of 23 biopsies, 20 (87%) yielded a correct diagnosis with specific histological typing for metastasis. Pneumothorax was the most common complication occurring in four cases (5.7%). Conclusion: CT-guided percutaneous transthoracic needle biopsy is a firm, useful and safe technique for the diagnosis of suspected pulmonary metastases as it avoids open biopsy in most cases. Keywords• CT-guided biopsy • lung metastasis • transthoracic needle biopsy It is known that the lungs are a common site for metastases from other primary cancers, such as breast, colon and sarcomas. Although in the patients with high-risk of lung metastasis the increasing utility of computed tomography (CT) low-dose screening has grown dramatically the sensitivity of identifying small lung nodules [1], CT-guided needle biopsy (CTgNB) of lung metastases (LM) with automatic or semi-automatic biopsy gun have proven to bring in diagnostic label with few complications and is widely accepted as accurate and safe procedure for characterizing pulmonary nodules. [2] Percutaneous transthoracic needle biopsy guided by CT is considered as a relatively well and safe method for diagnosing LM [3]. The rates of diagnostic accuracy have been documented between 72 and 100% for pulmonary metastatic lesions. However, the diagnostic accuracy decrease for smaller lesions between 10 and 20 mm; several studies have reported the diagnostic accuracy range of 52 and 96.5% [4,5].The purpose of our study was to review our experience with CT-guided biopsy of suspected LM with a view to providing a critical assessment of the efficacy and safety of the procedure.For reprint orders, please contact: reprints@futuremedicine.com

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Section: Discussionmentioning

confidence: 99%

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

et al. 2015

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“…With increasing pulmonary metastatic count, the overall survival is reduced and metastasectomy results in a greater loss of lung tissue [37]. However, with the surgical tools available, today even large numbers of metastases are accessible to surgical treatment.…”

Section: What Are the Limits?mentioning

confidence: 98%

“…One case report anecdotally reported a long-term survival after removing 117 nodules in a patient suffering from metastatic soft tissue sarcoma [39]. There is an agreement that if a patient is a candidate for pulmonary metastasectomy, the goal should be to resect all metastases, irrespective of the number [37].…”

Section: What Are the Limits?mentioning

confidence: 99%

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Pulmonary metastasectomy

et al. 2011

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Background: The major obstacle in curing cancer is the limited ability to prevent and treat metastatic disease. Pulmonary metastasectomy is now a standard treatment option in carefully selected cases. With the lung being frequently the only site of metastasis, a complete resection of all tumor masses poses a potentially curative treatment option.Methods: This review article gives an outline of the basics of pulmonary metastasectomy and reviews the latest research in this field.Results and conclusions: Technical advances in thoracic surgery during the past decades made pulmonary metastasectomy a safe procedure with a low morbidity. However, surgical resection must be embedded in an individualized oncological concept.The beginnings of pulmonary metastasectomy can be traced back to the 19th century. The first case of a resection of pulmonary metastases was reported in 1882. Josef Weinlechner, a Viennese pediatric surgeon, accidentally discovered and resected two metastatic nodules in the lung when removing a large sarcoma of the thoracic wall [1]. Unfortunately, this first patient died the day after surgery from shock. Throughout the following decades, single case reports of pulmonary metastasectomy have been described in the literature. In most cases, the resection of pulmonary nodules led to long-term survival. As open chest surgery in those times was itself a life-threatening intervention, beneficial effects of metastasectomy were often restrained by the high mortality and morbidity of the surgical procedure. Since these early days of pulmonary metastasectomy, many advances have been made in surgical techniques and perioperative patient care. Consequently, pulmonary metastasectomy has developed into one of the major surgical procedures in thoracic surgery [2].

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“…Unfortunately, most patients with pulmonary metastases will not be candidates for LM because the presence of comorbidities or the need of extended surgery (5,6). In these patients new approaches are available such as radiotherapy, radiofrequency and microwave ablation, and immunotherapy, but these treatments are in search of evidence (7).…”

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confidence: 99%

Extending Surgery for Pulmonary Metastasectomy: What Are the Limits?

Abstract: Evidence-based recommendations for extended treatment of lung metastasis are at best weak. We have summarized the available data to provide the most up to date information regarding extended surgery in an attempt to define limits in the treatment of lung metastasis.

Cited by 37 publications

References 20 publications

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

Pulmonary metastasectomy

Looking forward lung metastasectomy—do we need a staging system for lung metastases?

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