Oncologic Outcome after Pulmonary Metastasectomy as Part of Multidisciplinary Treatment in a Tertiary Oncological Center

Abstract

(1) Background: Pulmonary metastases are encountered in approximately one-third of patients with malignancies, especially from colorectal, lung, breast, and renal cancers, and sarcomas. Pulmonary metastasectomy is the ablative approach of choice, when possible, as part of the multidisciplinary effort to integrate and personalize the oncological treatment. (2) Methods: The study includes 58 consecutive cases of pulmonary metastasectomies, retrospectively analyzed, performed in 12 consecutive months, in which the pathology reports confirmed lung metastases. (3) Results: Most frequent pathological types of metastases were: 14 of colorectal cancer, 10 breast, 8 lung, and 8 sarcomas. At the time of primary cancer diagnosis, 14 patients (24.14%) were in the metastatic stage. The surgical approach was minimally invasive through uniportal VATS (Video-Assisted Thoracic Surgery) in 3/4 of cases (43 patients, 74%). Almost 20% of resections were typical (lobectomy, segmentectomy). Lymphadenectomy was associated in almost 1/2 of patients and lymph node metastases were found in 11.11% of cases. The mortality rate (intraoperative and 90 days postoperative) is zero. The OS after pulmonary metastasectomy is 87% at 18 months, and the estimated OS for cancer is 90% at 5 years. The worst outcome presents the patients with sarcomas and the best outcome—colorectal and lung cancer. The patients with 1 or 2 resected metastases presented 96% survival at 24 months. (4) Conclusions: After pulmonary metastasectomy, survival is favored by the small number of metastases resected (1 or 2), and by the dimension of metastases under 20.5 mm. The non-anatomic (wedge) type of lung resection may present a lower risk of death compared to lobectomy. No statistical significance on survival has the presence of lymphadenectomy, the laterality right/left lung, the upper/lower lobes. In the future, longer follow-up and prospective randomized trials are needed for drawing definitive conclusions.

Surgical Tactics in Lung Metastases: A Comprehensive Analysis and Perspectives for Clinical Decision Making

“…These criteria include confirmation of the diagnosis in patients with a history of neoplasia, presenting detectable lung nodules on follow-up CT scans, in addition to excision of residual mass after chemotherapy treatment. Obtaining adequate metastatic tissue for analysis and reducing tumor burden, especially for secretory tumors, are also essential considerations to ensure individual benefits for each patient (MOTAS, N. et al, 2023).…”

“…Ensuring an adequate prognosis requires a thorough investigation, covering detailed information about the patient, the type of lung metastasis, surgical selection parameters and the different surgical options available. Elements such as the number of metastases, primary location and extent of lymphatic excision play fundamental roles in determining survival (MOTAS, N. et al, 2023). The integration of these factors into therapeutic decisions provides a more comprehensive and personalized approach to the treatment of lung metastases, contributing to better clinical outcomes.…”

“…The lung, acting as a filter in the blood circulation, is frequently affected by metastases, with one third of patients with metastatic cancer presenting pulmonary involvement. Colorectal cancers, sarcomas, breast cancers, renal cell cancers and head and neck carcinomas are the main causes of lung metastases (MOTAS, N. et al, 2023). Recently, advances in scientific research have impacted both the diagnosis and treatment of this challenging clinical scenario.…”

“…Effective alternatives include stereotactic body radiation therapy (SBRT), laser enucleation, and local ablation techniques. Less invasive options, such as VAST (videothoracoscopy) and CT-guided high dose rate brachytherapy (CT-HDRBT), are preferable (MOTAS, N. et al, 2023). The systemic approach, before or after surgery, significantly impacts patient survival.…”

Determination of the timing for thoracic imaging prior to pulmonary metastasectomy: an analysis on surgical planning and lesion detection

“…1 About 30% of patients with malignant diseases develop pulmonary metastasis, which is the spread of cancer cells from the primary tumor to distant organs, significantly contributing to cancer morbidity and mortality. [2][3][4][5] Pulmonary metastases commonly originate from colon, rectum, kidney, breast, prostate, and oropharyngeal carcinomas, among others. The management of pulmonary metastases includes various strategies such as surgery, radiotherapy, and chemotherapy, with surgery recommended for patients in the oligometastatic stage who can tolerate the procedure.…”