Outcome of thoracoscopic pulmonary metastasectomy evaluated by confirmatory thoracotomy

Mutsaerts, Eduard L. A. R.; Zoetmulder, F.A.N.; Meijer, Sybren L.; Baas, Paul; Hart, A. A. M.; Rutgers, Emiel J. T.

doi:10.1016/s0003-4975(01)02629-7

Cited by 67 publications

(47 citation statements)

References 15 publications

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“…All three cases included patients with multiple disease and short DFI from the primary tumor surgery (up to 12 months). Mutsaerts found in his study peroperatively other metastases in almost 30 % of surgically treated patients, more often in multiple lesions which corresponds to our fi ndings (26). Therefore, in our opinion, the mini-invasive procedure can be accepted only in selected individuals with solitary metachromous peripheral metastases with a DFI of years after the primary tumor surgery (14,16).…”

Section: Discussionsupporting

confidence: 84%

“…The choice of surgery is similarly controversial. A signifi cant section of authors always recommend classical open thoracotomy, or sternotomy in case of a bilateral surgery while referring to the need for thorough palpation of pulmonary tissue in order to avoid overseeing any possible unidentifi ed pathological foci (16,25,26). For example, Loeche found in his study other metastases in almost 17 % of performed surgeries (27).…”

Section: Discussionmentioning

confidence: 99%

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Surgical therapy of pulmonary metastases – 10-year results

Vodička¹,

Spidlen²,

Šimánek³

et al. 2013

BLL

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Introduction:The surgical therapy of selected secondary pulmonary tumors, including both solitary and multiple or bilateral tumours, is currently a generally accepted therapeutic procedure demonstrably extending the long term survival of these patients. Purpose: The purpose of the present study is a ten-year retrospective analysis of a group of patients who underwent surgery due to pulmonary metastases of various primary tumors. Methods: In 2000-2009, 87 patients (of which 44 were male with a median age of 64 years) with secondary pulmonary tumors underwent surgery at the departments of the authors of this study. Solitary metastases were found in 60 patients, multiple metastases in the remaining patients, while 13 patients had bilateral metastases. The median disease-free period from surgery of the primary tumor was 31 months. Results: In total, 74 unilateral and 13 bilateral surgeries were performed in one or two periods. The most common type of surgery included anatomical pulmonary resections (32 procedures), wedge resections (29 procedures) and laser excisions (24 procedures). In total, the radical resection was performed in 156 metastases. Post-operative morbidity was 17.2 % with zero mortality. A proportion of 50.6 % of operated patients survived after resection of metastases with median survival of 39 months. The overall three-year and fi ve-year survivals in the group were 57 % and 38 %, respectively. A proportion of 35.6 % of patients live after resection of metastases without disease progression, and the median is 15 months. Conclusion:The achieved results confi rm the positive role of pulmonary metastasectomy in the therapy of disseminated cancer disease (Tab. 1, Fig. 5, Ref. 34 Hematogeneous pulmonary metastases are generally considered as a sign of advanced generalization of malignant disease. Up to one third of malignant tumors have pulmonary metastases, and in most of them the lungs are even the fi rst site of dissemination. Nevertheless, in a signifi cant number of patients, the pulmonary affl iction is stopped or eliminated during the dissemination of metastases, and these patients may benefi t from radical resection of metastases (1, 2). Surgical therapy of the selected secondary pulmonary tumors, not only solitary but also multiple or bilateral, is today generally the accepted therapeutic procedure which demonstrably extends long term survival of these patients with acceptable peri-operative morbidity and mortality. The purpose of the following study is a retrospective analysis of a group of patients who underwent surgery due to pulmonary metastases of various primary tumors over a period of ten years. Material and methodsIn 2000-2009 we performed surgery on 87 patients with secondary pulmonary tumors. Only patients who had undergone a radical resection of the primary tumor, were free from other extrapulmonary metastases, their pulmonary metastases appeared to be radically removable according to the pre-operative examinations as for the number and location, and the benefi t of surgery...

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Surgical therapy of pulmonary metastases – 10-year results

Vodička¹,

Spidlen²,

Šimánek³

et al. 2013

BLL

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“…Occurrence of pulmonary metastases is usually a poor prognostic factor, but in selected cases, mainly isolated, peripheral and small (<3 cm) metastatic lesions in patients with good general condition and without contraindications to surgical treatment, their removal is possible (12). In our material pulmonary metastasectomy was performed in patients with various neoplasms -mostly cancer of the large intestine, kidney, breast, uterus and lung, less often malignancies of other organs.…”

Section: Discussionmentioning

confidence: 99%

Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy

Rzechonek

Błasiak

Pniewski³

et al. 2018

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Abstract. Background (82.1±83.5 months vs. 43.0±44.4, p<0.01 and 110.7±81.3 months vs. 69.9±52.9 p<0.005, respectively). Survival after pulmonary metastasectomy was 27.2±25.6 months and was longer in obese and overweight patients than in normal weight patients (20.2±18.4 months vs. 29.4±26.5, p<0.05). Conclusion: Being obese or overweight is a favorable prognostic factor in patients after surgical resection of lung metastases of different malignancies.With the increasing epidemic of obesity in the world, the incidence of malignancies related to obesity also increases (1). Obesity-related cancers include breast cancer in postmenopausal women, colon cancer, cancer of the lower esophagus, gastric cancer, liver cancer, gall bladder cancer, pancreatic cancer, uterine cancer, ovarian cancer and renal cancer (2). Obesity is also associated with increased risk of metastases, including lung metastases, in some cancers (3).In the course of some malignancies a paradoxical phenomenon has been observed, indicating that obesity may be an oncogenic factor and -at the same time -may constitute a favorable prognostic factor (4, 5). The dual and opposite influence of obesity on the course of the same disease has been called the obesity paradox and has been described in some chronic diseases, including cardiovascular (6) and cerebrovascular diseases (7). These paradoxical effects of obesity may occur also in patients with metastases, including patients with malignancies not related to obesity. In a recent large-scale study of 4,010 cancer patients in good general condition, with distant metastases, median OS was twice as high in obese patients as in normal weight patients (8). However, there are also reports stating that there is no beneficial effect of obesity on metastatic neoplastic disease (9-11).The problem of the influence of obesity on the course of metastatic malignancies has not yet been unequivocally explained. Especially, there are no studies on the influence of obesity on survival of patients with operable lung metastases. Therefore, this study was undertaken to evaluate the long-term outcome of surgical treatment of obese and non-obese patients who after resection of primary neoplasm had lung metastases removed. Materials and MethodsData from 99 patients who had a resection of lung metastasis from different primary malignancies between 2001 and 2016 were analyzed. The study was retrospective, and the condition for including patients in the study was access to anesthesia documentation containing body weight and height prior to performing pulmonary metastasectomy. Analysis was performed in the groups depending on body mass index (BMI). Underweight was diagnosed when the BMI 197

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“…It is primarily used for diagnostic purposes but more and more surgeons use it to perform oncologic resections (20,21). The major advantage of VATS is the lower morbidity, shorter hospital stay and decreased intrathoracic adhesions, improving the feasibility of reoperation compared to open procedures (22).…”

Section: The Surgical Approachmentioning

confidence: 99%

“…Early studies showed that VATS was inferior to open thoracotomy because of the loss of tactile sensation and subsequently missing lesions that did not show up on preoperative imaging (23). However, with the improvement of preoperative imaging, more recent studies indicate that VATS might result in similar LUNG METASTATIC DISEASE: SURGICAL RESECTION AND LOCOREGIONAL CHEMOTHERAPY survival compared to thoracotomy in selected patient groups (21,(24)(25)(26). These studies were performed in patients with 1 or 2 small peripherally located lesions which are easily accessible with VATS.…”

Section: The Surgical Approachmentioning

confidence: 99%

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

Hengst¹,

Hendriks²,

Schil³

2012

Toraks Cer Bult

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Currently, surgical resection remains the gold standard for resectable lung metastases. Prognostic factors are histology, complete resection, number of metastases and disease-free interval. However, there is a high rate of recurrent disease in the thorax, even if systemic chemotherapy is applied. Because the latter is limited in dose due to systemic toxicity, new treatment options are being developed to selectively deliver high-dose chemotherapy into the lung, reducing systemic toxicity. Isolated lung perfusion (ILuP), similar to isolated limb perfusion, is an experimental surgical technique to deliver highdose chemotherapy into the lung without systemic exposure. Biological response modifiers like tumour necrosis factor can also be administered. ILuP results in significantly higher concentration of chemotherapy in the target organ compared to systemic chemotherapy, together with a survival benefit in experimental models of pulmonary metastases. Several phase I studies have shown that ILuP is technically feasible with low morbidity and low impact on the patient's pulmonary function. However, the utility of this technique is limited because it is an invasive technique. Other techniques to selectively deliver high-dose locoregional chemotherapy are embolic trapping (chemo-embolization), selective pulmonary artery perfusion (SPAP) without control of the venous effluent and the minimally invasive lung suffusion technique. This review will discuss surgical resection of lung metastases and address several techniques developed to deliver high doses of chemotherapy into the lung, as well as the current progress in experimental and clinical studies.

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Outcome of thoracoscopic pulmonary metastasectomy evaluated by confirmatory thoracotomy

Cited by 67 publications

References 15 publications

Surgical therapy of pulmonary metastases – 10-year results

Surgical therapy of pulmonary metastases – 10-year results

Influence of Obesity on the Course of Malignant Neoplastic Disease in Patients After Pulmonary Metastasectomy

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

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