Thoracoscopic lung metastasectomies: a 10-year, single-center experience

Abstract

IntroductionThe ideal surgical treatment for pulmonary metastasectomy remains controversial. Minimally invasive surgery may offer advantages for quality of life outcomes, with equivalent oncologic long-term results. The purpose of our study was to confirm the validity of the thoracoscopic approach for pulmonary metastasectomy.MethodsWe retrospectively reviewed 164 patients who underwent 212 lung metastasectomies from January 2000 to December 2010. Complete curative pulmonary resections were performed in 159 (96.95 %) cases; 126 patients developed lung metastases from epithelial tumors: 28 from sarcoma, 7 from melanoma, and 3 from germ cell tumors. The mean disease-free interval (DFI) was 38.75 months. Fifty-four patients underwent a major VATS resection (53 thoracoscopic lobectomies and 1 pneumonectomy), and 110 patients underwent a wedge resection/segmentectomy. Lymph node sampling was performed in 117 cases.ResultsAfter a mean follow-up of 38 months, 87 patients (53 %) had died. All resection margins were tumor-free at final pathological examination. Multivariate analysis not confirmed in our series a better prognosis for patients with a particular histologic type and also DFI, age, number of metastases, and type of surgery did not statistically influence long-term survival.ConclusionsThoracoscopic surgery is an acceptable procedure, safe and efficacious, with a 5-year overall survival that is equivalent to open surgery.

Thoracoscopic resection of pulmonary metastasis: Current practice and results

“…The 3-year overall survival rate and the 3-year intrathoracic disease-free survival rate were 59.8% and 33.4% respectively. Recently, Lo Faso and colleagues [42] reported a single-center series of 164 patients who underwent 212 VATS lung metastasectomy from 2000 to 2011. They performed 133 wedge, 22 segmentectomies, 54 lobectomies and 1 pneumonectomy.…”

Management of Sarcoma Metastases to the Lung

“…This represents selection bias and highlights the careful selection of patients for thoracoscopy. With this in mind, several new studies (albeit with mixed tumor histologies) do support the increasing use of VATS in select patients for pulmonary metastasectomy [34, 35, 36]. The controversy of open vs. VATS resection for PM for sarcoma highlights the importance of careful patient selection and understanding disease behavior.…”

“…Lo Faso et al found nodal involvement in only 20% of patients, and involvement was not significantly associated with an overall difference in survival [34]. In the only study in which a systematic mediastinal and hilar lymph node dissection was performed, Pfannschmidt et al found thoracic lymph node involvement in 20.3% of patients with sarcoma, and an improved median survival for N0 patients (47 months for N0 and 18.3 months for N1, p=0.036) [41].…”

Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas

“…We do not recommend performing mediastinal lymphadenectomy. Its impact is negligible (IVD) 85 We recommend, when possible, video thoracoscopy in cases of oligometrical disease or peripheral lesions (IVB) 86 …”

“…Its impact is negligible (IVD). 85 • We recommend, when possible, video thoracoscopy in cases of oligometrical disease or peripheral lesions (IVB). 86 • For patients with synchronous metastases at the diagnosis, in the absence of extrapulmonary disease, the initial treatment of choice is systemic chemotherapy.…”