Optimal surgical management of pulmonary metastases: VATS versus thoracotomy

Abstract

Survival benefit after pulmonary metastasectomy is under question and knowledge of functional recovery after pulmonary metastasectomy by thoracotomy and video-assisted thoracoscopic surgery (VATS) is of great importance. We analysed prospective data of 100 patients operated for pulmonary metastasis by either VATS or thoracotomy. VATS yielded a better physical performance 1 month postoperative, shorter hospital stay, a shorter duration of chest tube drainage and epidural analgesia. We concluded that VATS is the preferable approach due to superior functional outcome.Key words: pulmonary metastasectomy, quality of life, thoracotomy, video-assisted thoracoscopic surgery.In current literature, the value of pulmonary metastasectomy is still under debate and often questioned on the actual survival benefit. Despite the lack of substantial evidence, the practice of pulmonary metastasectomy increased significantly in the last decade.1 Therefore, the question arises 'what is state of the art for pulmonary metastasectomy: open resection or a minimal invasive approach (video-assisted thoracoscopic surgery (VATS))'?In retrospective studies, comparing an open to a minimal invasive technique, no approach has shown superior oncological outcome.2,3 Eckardt et al. showed that the use of VATS resulted in missed nodules with potential malignant origin. 4 However, the clinical relevance of these missed nodules is not clear. With more unanswered questions added, we focused on the functional outcome for patients with pulmonary metastasis susceptible to operation and asked ourselves: 'What is the effect of either surgical techniques on quality of life (QoL) in patients with pulmonary metastasis'?To answer this question we used prospectively collected data, including results of QoL and pain questionnaires, to compare the short-and long-term functional recovery after pulmonary metastasectomy by thoracotomy and VATS. From April 2006 to December 2011, 100 patients operated for pulmonary metastasis were selected to undergo either a VATS approach or a thoracotomy. The choice of operative approach (i.e. VATS or thoracotomy) depended on tumour size, tumour location and patients' health status. In general, in patients with large and/or centrally located tumours, an open approach was used. Small, peripheral located nodules in patients with limited pulmonary function were removed by VATS.Patients were identified in a multidisciplinary care path for thoracic surgery in the Netherlands Cancer Institute.5 All patients with (potentially) malignant pulmonary lesions scheduled for lung resection were asked to participate in this care path, including prospective data registration, which was approved by the Institutional Review Board. Patient, tumour, treatment and outcome characteristics were collected. Exclusion criteria for participation were age younger than 18 years, inability or refusal to complete QoL questionnaires and resection of lung tissue as part of a chest wall resection. Patients were excluded when they received adjuvant (VATS N = 8, thorac...

How many times 125I seed implantation brachytherapy can be repeated for pulmonary metastases: clinical efficacy and complications

“…There is a potential survival benefit for patients who undergo pulmonary metastasectomy, even those with RPM [7,8]. Therefore, it is necessary to treat pulmonary metastases actively, but thoracotomy and video-assisted thoracoscopic surgery elicit considerable trauma [9].…”

Pulmonary metastasectomy: an overview

“…Both video-assisted thoracic surgical (VATS) techniques and open thoracotomy are accepted as appropriate incisions for performing pulmonary metastasectomy (16); on one side, open techniques have been shown to lead to the detection and hence, resection of more metastases than VATS techniques, in particular in case of nodule deeply embedded within the parenchyma (16)(17)(18). On the contrary VATS has been considered a preferable approach due to superior functional outcome, offering a shorter hospital stay, a shorter duration of chest tube drainage and epidural analgesia (19) (Figures 1,2).…”

Year in review 2016: Respiratory infections, acute respiratory distress syndrome, pleural diseases, lung cancer and interventional pulmonology

“…Numan et al . prospectively analysed a cohort of patients with pulmonary metastases to decipher which surgical option, VATS versus thoracotomy, led to superior QOL.…”