The Effect of Metastasectomy: Fact or Fiction?

Åberg, Torkel; Malmberg, Kjell-Åke; Nilsson, Berith; E, Nõu

doi:10.1016/s0003-4975(10)61278-7

Cited by 119 publications

(66 citation statements)

References 22 publications

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“…The authors proposed that improved patient survival was a result of the process of patient selection and not an effect of metastatectomy. Aberg published similar views were previously (33,34). The authors emphasize the need for randomized trials to determine the true, and not the perceived, effect of pulmonary metastatectomy.…”

Section: Sarcomasupporting

confidence: 67%

Results of Pulmonary Resection

Ceppa

2016

Thoracic Surgery Clinics

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SynopsisPulmonary metastasis can be present in as frequently as 88% and 80%, respectively, of patients with sarcoma and germ cell tumour with metastatic disease. In both sarcoma and germ cell tumour, pulmonary metastatectomy may be the only means of rendering a patient diseasefree. Sublobar (wedge or segmentectomy), lobectomy, and, rarely, pneumonectomy can be safely performed to achieve complete resection. Bilateral disease can be resected via staged thoracoscopy/thoracotomy, median sternotomy, or clamshell thoracotomy. Finally, multiple resections and re-resections in select patients have resulted in improved survival. The main principle of pulmonary metastatectomy is complete resection. In the appropriately selected patient 5-yr survival rates of as high as 35-52% for sarcoma, and 80% for germ cell tumour can be realized. -Large case series of pulmonary metastatectomy of nonseminomatous germ cell tumour (NSGCT) have reported 5-year survival rates greater than 80%.-There are no randomized trials on pulmonary metastatectomy in patients with metastatic sarcoma or NSGCT. Survival rates are from case series of selected patients without observation control arms for comparison.

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Section: Sarcomasupporting

confidence: 67%

Results of Pulmonary Resection

Ceppa

2016

Thoracic Surgery Clinics

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“…Compared with the 104 patients in group 2, the 50 patients selected for pulmonary metastasectomy had far fewer metastases (median 1, range 1-5 vs. 5, 1-15) and a much longer interval before metastases were evident (median 24 months, range 0 -119 months vs. 5, 0 -76). These are well-established factors associated with survival variation in patients with pulmonary metastases, irrespectiveofwhethertheydoordonothavemetastasectomy [5].So,to ask the 30-year-old question [6], is it the selection rather than the surgery that explains the difference?We agree with the authors' final conclusion: "From a medical oncology point of view, however, our results add evidence to the debate on whether or not such a study is still necessary." Their data, which show the large differences in selection criteria between those who did and did not have pulmonary metastasectomy, emphasize the need for an even-handed comparison.…”

supporting

confidence: 57%

mentioning

confidence: 99%

Randomized Controlled Trial of Pulmonary Metastasectomy in Colorectal Cancer: PulMiCC International Is Open in Italy

2013

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While reporting a comparative analysis of 409 patients with pulmonary metastases because of colorectal cancer, Tampellini and colleagues write: "To solve the debate, a phase III, prospective, randomized clinical trial … has been advocated" [1]. The trial cited [2] is PulMiCC (Pulmonary Metastasectomy in Colorectal Cancer). At the time of writing, 123 U.K. patients have been recruited and 36 of them have been randomized to either pulmonary metastasectomy or not, with both groups being actively monitored. PulMiCC International is open for recruitment in Catania, Italy.We are running the trial because we agree with the statement of Tampellini and colleagues, "From a statistical point of view, our findings are insufficient to definitively solve the question of whether or not surgery is beneficial in resectable patients because this can be demonstrated only with a prospective, randomized, phase III trial" [1]. They nicely show the statistical limitations of observational data. They identified 1,411 patients with metastatic colorectal cancer between 1994 and 2010. Of these patients, 409 (29%) had pulmonary metastases and in 154 (11%), metastases were confined to the lung; 50 patients (3.5%) were selected to have pulmonary metastasectomy. This illustrates the problem of the shrinking denominator in selection of patients for pulmonary metastasectomy. As the authors state, this information is not generally captured in surgical follow-up studies where the starting point is a retrieved list of patients who had pulmonary metastasectomy. Exceptions include reports from the U.S. DepartmentofVeteransAffairs[3]andaClevelandClinicstudyof liver and lung versus lung only metastasectomy [4], which showed a similarly high degrees of selection.If we consider the 154 patients with lung-only metastases, 50 (32%) were selected for surgery (group 3) while the remaining 104 (group 2) were selected to not have surgery [1]. The groups are very different on critical baseline characteristics. Compared with the 104 patients in group 2, the 50 patients selected for pulmonary metastasectomy had far fewer metastases (median 1, range 1-5 vs. 5, 1-15) and a much longer interval before metastases were evident (median 24 months, range 0 -119 months vs. 5, 0 -76). These are well-established factors associated with survival variation in patients with pulmonary metastases, irrespectiveofwhethertheydoordonothavemetastasectomy [5].So,to ask the 30-year-old question [6], is it the selection rather than the surgery that explains the difference?We agree with the authors' final conclusion: "From a medical oncology point of view, however, our results add evidence to the debate on whether or not such a study is still necessary." Their data, which show the large differences in selection criteria between those who did and did not have pulmonary metastasectomy, emphasize the need for an even-handed comparison. PulMiCCisdesignedsothatpatientsandclinicalteamscandecide for or against pulmonary metastasectomy. If, after standard clinical assessment, the better course ...

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“…Para alguns tipos histológicos, como, por exemplo, sarcoma de partes moles, as metástases pulmonares podem representar o primeiro local de recidiva em 50% dos pacientes 1 . Em uma série, mais que 70% dos pacientes com metástases pulmonares isoladas foram curados e livres de doença após ressecção dessas lesões 2 .…”

Section: Introductionunclassified

Ressecção cirúrgica de metástases pulmonares: estudo prospectivo em 182 pacientes

Younes¹,

Haddad²,

Ferreira³

et al. 1998

Rev. Assoc. Med. Bras.

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RESUMO -OBJETIVO. O presente estudo visa ava UNITERMOS:Metástases. Pulmão. Prognóstico. Cirurgia. INTRODUÇÃOO diagnóstico de metástases pulmonares em pacientes portadores de tumores malignos é considerado um sinal de doença sistêmica e por muitos anos caracterizado como fase terminal da evolução do paciente. O tratamento convencional de pacientes com metástases pulmonares consiste em quimioterapia, hormonioterapia e, por vezes, radioterapia. Os resultados observados nos diferentes estudos apresentam resposta objetiva ao tratamento que não alcança 30% a 40% dos pacientes e com raros casos de resposta completa e conseqüen-te potencial de cura (sobrevida global de cinco anos geralmente inferior a 1%). Esses tratamentos são considerados por muitos especialistas como essencialmente paliativos.Para alguns tipos histológicos, como, por exemplo, sarcoma de partes moles, as metástases pulmonares podem representar o primeiro local de recidiva em 50% dos pacientes 1 . Em uma série, mais que 70% dos pacientes com metástases pulmonares isoladas foram curados e livres de doença após ressecção dessas lesões 2 .Apesar de múltiplos trabalhos na literatura mundial descreverem séries de pacientes submetidos à ressecção cirúrgica de metástases pulmonares, a literatura latino-americana é ainda muito pobre nesses estudos, com poucos relatos nesse sentido [3][4][5][6] . A maior série publicada na literatura latino-americana é de Esteva et al. 7 , que apresentaram um estudo retrospectivo de 61 pacientes operados durante um período de 14 anos. O núme-ro pequeno de casos e o período muito longo durante o qual foram admitidos esses pacientes tornam as conclusões deste e de outros estudos muito cautelosas. Por outro lado, a maioria absoluta dos estudos publicados na literatura mundial consiste em avaliações retrospectivas de prontuários acumulados durante muitos anos 8 . O presente estudo tem por objetivo: 1) avaliar de forma prospectiva, com protocolo rígido (evitando grandes flutuações de indicações, técnicas e tecnologia médica) realizado em curto período de tempo, os resultados do tratamento cirúrgico de metás-tases pulmonares; 2) identificar subgrupos de pacientes com riscos variados de recidiva e de morte decorrente da doença, baseado no impacto de fato-

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The Effect of Metastasectomy: Fact or Fiction?

Cited by 119 publications

References 22 publications

Results of Pulmonary Resection

Results of Pulmonary Resection

Randomized Controlled Trial of Pulmonary Metastasectomy in Colorectal Cancer: PulMiCC International Is Open in Italy

Ressecção cirúrgica de metástases pulmonares: estudo prospectivo em 182 pacientes

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