Lung Metastatectomy: Can Laser-Assisted Surgery Make a Difference?

Abstract

Background: Resection of lung metastases with curative intention in selected patients is associated with prolonged survival. Laser–assisted resection of lung metastases results in complete resection of a high number of lung metastases, while preserving lung parenchyma. However, data concerning laser lung resections are scarce and contradictory. The aim of this study was to conduct a systematic review to evaluate the utility of laser-assisted pulmonary metastasectomy. Methods: An electronic search in MEDLINE (via PubMed), complemented by manual searches in article references, was conducted to identify eligible studies. Results: Fourteen studies with a total of 1196 patients were included in this metanalysis. Laser-assisted surgery (LAS) for lung metastases is a safe procedure with a postoperative morbidity up to 24.2% and almost zero mortality. LAS resulted in the resection of a high number of lung metastases with reduction of the lung parenchyma loss in comparison with conventional resection methods. Survival was similar between LAS and conventional resections. Conclusion: LAS allows radical lung-parenchyma saving resection of a high number of lung metastases with similar survival to conventional methods.

BipoJet Scissors as an Alternative to Laser in Lung Wedge Resection

“…Laser resection of lung metastases has long been promoted in the scientific literature [ 7 , 13 ] as well as in the lay press and on the internet [ 14 , 15 ]. Laser metastasectomy significantly reduces the loss of parenchyma, although the oncologic benefit of laser resection over high-frequency resection or conventional clamp resection has never been proven to be significantly superior [ 5 , 6 , 10 ].…”

“…At present, Nd:YAG (neodymium-doped yttrium aluminum garnet) lasers are increasingly used to resect lung metastases. Laser metastasectomy significantly reduces parenchymal loss, but its effect on long-term survival remains unclear [5][6][7].…”

Radiomics in Lung Metastases: A Systematic Review

“…Treatment options for LM may include local therapies, such as thermal ablation techniques and stereotactic ablative body radiation [ 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 ], chemotherapy [ 97 , 98 ] and, in selected cases, surgery [ 99 , 100 , 101 ]. The introduction of new systemic treatments, including immunotherapy and target therapies, has improved the prognosis of patients with metastatic tumors, but only a subset of mutated patients can benefit from such treatments [ 102 ].…”

Are Extensive Open Lung Resections for Elderly Patients with Lung Cancer Justified?

“…In recent years, improvements in video-assisted thoracic surgery (VATS) such as uniportal VATS and non-intubated VATS, as well as preoperative tumor localization (e.g., with the placement of wires preoperatively), have extended indications and possibilities for thoracic surgical resections, even for elderly patients. However, open lung resections are still performed whenever it is indicated [ 4 , 5 , 6 , 7 ].…”