Is repeated pulmonary metastasectomy justified?

Abstract

Recurrence after pulmonary metastasectomy (PM) is frequent, but it is unclear to whom repeated pulmonary metastasectomy (RPM) offers highest benefits. Retrospective analysis of oncological and post-operative outcomes of consecutive patients who underwent PM from 2003 to 2018. Overall survival (OS) and disease-free interval (DFI) were calculated. Cox regression was used to identify variables influencing OS and DFI. In total, 264 patients (female/male: 114/150; median age: 62 years) underwent PM for colorectal cancer (32%), sarcoma (19%), melanoma (16%) and other primary tumors (33%). Pulmonary metastasectomy was approached by video-assisted thoracic surgery (VATS) in 73% and pulmonary resection was realized by non-anatomical resection in 76% of cases. The overall median follow-up time was 33 months (IQR 16–56 months) and overall 5-year survival rate was 62%. Local or distant recurrences were observed in 172 patients (65%) and RPM could be performed in 66 patients (25%) for a total of 116 procedures. RPM was realized by VATS in 49% and pulmonary resection by wedge in 77% of cases. In RPM patients, the 5-year survival rate after first PM was 79%. Post-operative cardio-pulmonary complication rate (13% vs. 12%; p = 0.8) and median length of stay (4 vs. 5 days; p = 0.2) were not statistically different between first PM and RPM. Colorectal cancer (HR 0.56), metachronous metastasis (HR 0.48) and RPM (HR 0.5) were associated with better survival. In conclusion, our results suggest that RPM offers favorable survival rates without increasing post-operative morbidity.

Outcome of Repeated Resection of Pulmonary Metastases for Renal Cell Cancer

“…However, only 20% of these patients would be treated with RPM. 4,[14][15][16][17][18][19] In our study, 64 patients after PM, 78% of the initial study population were identified with a tumor relapse in the follow-up. Only 26 patients of This document was downloaded for personal use only.…”

ERS International Congress 2021: highlights from the Thoracic Surgery and Lung Transplantation Assembly

“…Stage 3 (Orange) represents an intermediate group where a cautious indication may exist [ 18 , 19 ]. Although preliminary successful validation has been reported at the meeting on a retrospective cohort of 264 patients, this approach is being validated in a larger group of patients [ 20 ].…”

Is survival really better after repeated lung metastasectomy?

“…The phenomenon has been observed in at least four of the observational studies in the list of references in the paper by Dr Forster and colleagues. (1) We addressed the matter in an Editorial in the Journal of Thoracic and Cardiovascular Surgery five years ago, using data from the work of the late Professor Mineo(2) and we have reconsidered the conundrum in the light of this new study. (1) The first place to look for a possible explanation is in the Kaplan-Meier curves in Fig.…”

“…(1) We addressed the matter in an Editorial in the Journal of Thoracic and Cardiovascular Surgery five years ago, using data from the work of the late Professor Mineo(2) and we have reconsidered the conundrum in the light of this new study. (1) The first place to look for a possible explanation is in the Kaplan-Meier curves in Fig. 1 because that is the most readily grasped presentation of the data and contains the time to death of all 246 patients.…”