Pulmonary laser-assisted metastasectomy is associated with prolonged survival in patients with colorectal cancer

Abstract

Background: Pulmonary metastases develop in 10-15% of patients with colorectal cancer. Surgical metastasectomy currently provides the only hope for a cure for these patients. The aim of this study was to analyze the expanding role of pulmonary metastasectomy in the context of laser-assisted surgery (LAS) vs.non-laser-assisted surgery (NLAS). Methods: We performed a single-center retrospective analysis of 204 patients who underwent curative pulmonary metastasectomy for colorectal cancer between 01/2005 and 12/2016. The main endpoint was survival. The Kaplan-Meier method was applied for statistical analysis and survival rates were compared with the log rank test. Results: Median follow-up was 53 months. A total of 267 metastases were resected in 154 operations in the NLAS group (median: 1) vs. 438 metastases in 122 operations in the LAS group (median: 5; P<0.0001). The interval between treatment of the primary tumor and the first pulmonary metastasectomy was significantly shorter in the LAS group (19 vs. 32 months; P=0.008). Anatomical resections were significantly reduced using LAS, 8% vs. 23% respectively. Despite more negative predictors in the LAS group, there was no statistically significant difference in overall disease-specific 5-year survival (70% LAS vs. 58% NLAS; P=0.18).Conclusions: Survival after pulmonary metastasectomy has previously been shown to correlate with a low number of metastases and a longer disease-free interval. However, with the tissue-saving LAS technique complete resectability can be achieved in patients with more metastases and long-term survival is possible for selected patients.

Surgical Morbidity and Lung Function Changes After Laser–Assisted Pulmonary Metastasectomy: A Prospective Bicentric Study

“…In most previous trials PM is also associated with little or no mortality, reasonable morbidity and, in selected cases, long-term survival ( 1 – 3 , 8 ). These findings contradict the notion of surgery being essentially more harmful when compared to systemic treatment and radiotherapy.…”

“…Recent studies have compared LAS to conventional PM regarding oncologic outcome and survival. Main findings of these retrospective trials were the possibility of resection of many metastases using a laser-device with good long-term results ( 3 , 9 , 11 ). LAS is believed to help in preserving lung parenchyma, particularly in case of resection of many metastases, by reducing the damage and deformation to the adjacent lung tissue by precise application of energy.…”

“…Pulmonary metastasectomy was associated with a survival benefit in selected patients in numerous retrospective trials; however, survival benefit has yet to be proven in prospective randomized studies (1)(2)(3)(4)(5)(6)(7)(8). Different surgical techniques are used for PM including staplers, cautery devices, Ligasure/Ultracision-System as well as Nd:YAG-Lasers.…”

“…Different surgical techniques are used for PM including staplers, cautery devices, Ligasure/Ultracision-System as well as Nd:YAG-Lasers. Laser-assisted-resection (LAS) is believed to facilitate the complete resection of metastases is associated with long-term survival in selected patients (2,3,(9)(10)(11). LAS devices enable the oncologic surgeon to resect lesions with high precision causing only minimal deformity to the adjacent lung tissue and thus to preserve healthy lung tissue.…”

Lung metastases from colorectal cancer: a multidisciplinary approach and role of local treatment: a narrative review

“…In patients who underwent laser assisted surgery for metastasectomy, there was an association with improved survival, while the rates of complications including atrial fibrillation, pneumonia, prolonged chest tube placement and empyema were not increased compared to patients who underwent non-laser resection. Laser assisted surgery can minimize tissue damage and preserve respiratory function according to an animal study (88), and complete resection of all the pulmonary metastases was possible in a retrospective clinical series in patients who had adequate lung function (89).…”