Experience of Simultaneous Bilateral Open Surgery and VATS for Pulmonary Metastasectomy

Abstract

Background Resection is the current treatment of choice for resectable bilateral pulmonary metastases. This study aimed to compare the differences in outcomes between simultaneous bilateral open and video-assisted thoracic surgery (VATS) for pulmonary metastasectomy. Methods Forty-three patients underwent pulmonary metastasectomy through one-stage bilateral open thoracotomy (n = 16) and VATS (n = 27) between 2011 and 2020. Perioperative and oncological data were analyzed. Results The predominant primary tumor histology in both groups was colorectal cancer. The operative time, blood loss, and pain score on postoperative day 1 (POD1) were higher in the open group (p < 0.001, 0.009, and 0.03, respectively). No significant differences in pain score on POD2 and POD3, postoperative length of stay, or complications were found. Notably, numbers of the resected metastatic lung nodules were significantly greater in the open group (median number: 9.5 vs. 3, p < 0.001). Recurrence-free survival (RFS) and overall survival (OS) were comparable. The median RFS was 15 months (interquartile range [IQR], 6–22) in the open group and 18 months (IQR, 8–47) in the VATS group. The median OS was 28 months (IQR, 14–44) and 29 months (IQR, 15–54) in the open group and VATS group, respectively. Conclusion One-stage bilateral pulmonary metastasectomy is safe and reduces medical expenditures in selected patients regardless of surgical approach. Although the open group harbored a greater number of metastatic foci, perioperative and oncological outcomes were similar to that of the VATS group.

Lobectomy Versus Sublobar Resection in Simultaneous Bilateral Thoracoscopic Lung Resection

“…In conclusion, one-stage surgery for managing a wide array of thoracic diseases is proven to be safe and efficacious [1][2][3][4][5][6][7][8][9][10]15], and its advantages include circumventing the risk of contralateral tumor progression, comparable wound pain when compared with unilateral-side surgery, decreased medical cost, and decreased psychological burden. In our study, SBTLR allowed clear pathological discrimination in patients with indeterminate lung neoplasms and produced a perioperative course with a comparable safety profile.…”

“…Subsequently, the patient was moved into the contralateral decubitus position for the more complicated operation (i.e., lobectomy or complex segmentectomy). Prioritization of the simpler side allowed for safer resection of the contralateral side, which is an approach based on our experience with simultaneous bilateral surgical treatment of metastases and bronchiectasis [2, 15]. For small neoplasms deemed non‐visible or non‐palpable, we often utilized patent blue dye for preoperative CT‐guided localization of the lesions, before commencing sublobar resections such as wedge resection or simple segmentectomy.…”

“…Simultaneous bilateral pulmonary surgery has been proven to be a safe and efficacious approach for a wide array of thoracic diseases, including but not limited to primary spontaneous pneumothorax (PSP), bilateral pulmonary metastases, and bilateral multifocal ground glass opacities (GGOs) suggestive of early primary lung cancer [1][2][3][4][5][6][7][8][9][10]. There has been increased interest in the feasibility of this treatment strategy when performed with video-assisted thoracoscopic surgery (VATS).…”

The diagnosis and management of multiple ground-glass nodules in the lung

“…Given the intricacies of thoracic surgery, unilateral procedures have traditionally been favored in clinical practice; however, recent evidence challenges this notion. A study involving 151 patients demonstrated that for individuals without relevant risk factors, bilateral surgeries do not result in increased severity or complications [36], there is a greater body of literature available to substantiate this conclusion [37,38]. However, further controlled trials are still required to substantiate this conclusion.…”