Pulmonary metastasectomy for testicular germ cell tumors: A 28-year experience

Liu, David; Abolhoda, Amir; Burt, Michael; Martini, Nael; Bains, Manjit S.; Downey, Robert J.; Rusch, Valerie W.; Bosl, George J.; Ginsberg, Robert J.

doi:10.1016/s0003-4975(98)00940-0

Cited by 87 publications

(56 citation statements)

References 22 publications

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“…In a large series of 5206 patients, Pastorino et al declared that germ cell carcinomas have the best survival and melanomas have the worst survival after PM operation, indicating the importance of the primary tumor's histopathology, finding an MST of 40 months for epithelial tumors, 29 months for sarcomas, and 19 months for melanoma patients after PM; germ cell tumor patients with distinct prolonged survival (7). Liu et al also found a 5-year survival rate of 68% in germ cell carcinoma patients undergoing PM (9). In an additional study, 5-and 10-year survival rates for metastasectomy patients after epithelial tumors were reported as 47% and 38%, respectively, with a mean survival of 61 months (5).…”

Section: Discussionmentioning

confidence: 90%

“…The result of their study revealed that its sensitivity was 86.7% and specificity was 100%. In high-risk surgical patients, fine needle aspiration biopsy or a thoracoscopic lung biopsy can be considered for a definitive diagnosis before proceeding to the thoracotomy stage (9). With any suspicion of a possible nodule, thorax CT is used to verify the exact count and localization of the lesions.…”

Section: Discussionmentioning

confidence: 99%

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Who Actually Profits from Pulmonary Metastasectomy Operation? Retrospective Analysis of 12 Years

Evman¹,

Demirhan²,

Cardak³

et al. 2015

Eurasian J Pulmonol

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Objective: Evaluating the benefits of metastasectomy and the possible prognostic factors associated with overall survival after surgical treatment. Methods:Between January 2000 and January 2012, 148 pulmonary metastasectomy operations were performed on 126 patients (78 males, 48 females), with a median age of 32. Data were examined retrospectively for age, gender, primary tumor histology, number of lesions, operative techniques, resection margins, mediastinal lymph node involvement, time to metastasis, and additional therapies. Effects of possible prognostic factors on 2-year and 5-year survival were then evaluated.Results: Most patients (84%) were asymptomatic; 126 patients underwent 148 metastasectomy operations. Definitive pathology revealed sarcoma in 63 (50%), epithelial tumor in 58 (46%), and melanoma in 5 (4%). Complete resection (R0) was achieved in all patients. Average postoperative hospital length of stay was 5.4 (range: 2-8) days. Morbidity was 6.3%, and 30-day mortality was 1.6%. Median overall survivals were found to be 42, 27, and 11 months (p=0.029), with median disease-free intervals of 32, 21, and 7 months for epithelial tumors, sarcomas, and melanomas, respectively (p<0.001). The median survival of patients with single, 2 to 3, and 4+ metastatic nodules was 30, 18, and 15 months, respectively (p=0.012). Median survival of patients with a disease-free interval of less than 12 months was 16 versus 30 months in those with an interval of more than 12 months (p=0.003). Additional mediastinal lymph node involvement was directly correlated with a worse outcome (p=0.044). Conclusion:Pulmonary metastasectomy is a safe and effective choice of treatment. Univariate analyses verified that histopathology of the tumor, disease-free interval, number of metastatic lesions, and lymph node involvement were significant prognostic factors in patients undergoing pulmonary metastasectomy.Keywords: Lung metastases, pulmonary metastasectomy, secondary neoplasm, surgery, survival analysis ÖzetAmaç: Bu makalede, pulmoner metastazektomilerin sağkalıma olan katkısı ve sağkalıma etki eden diğer prognostik faktörler araştırıldı.Yöntemler: Ocak 2000 -Ocak 2012 tarihleri arasında 126 hastaya 148 pulmoner metastazektomi uygulandı. Hastaların 78'i erkek, 48'u kadın olup ortalama yaş 32 idi. Hastalar yaş, cinsiyet, primer tümör histolojisi, lezyon sayısı, ameliyat teknikleri, komplet ve inkomplet rezeksiyon sayıları, mediasten lenf nodu tutulumu, hastalıksız yaşam süreleri ve ek tedavi yönünden incelendi. Prognostik faktörlerin iki ve beş yıllık sağkalım üzerine etkileri değerlendirildi. Bulgular:Hastaların çoğunluğu (%84) asemptomatik idi. 126 hastaya 148 cerrahi girişim uygulandı. Olguların 63'unde (%50) sarkom, 58'inde (%46) epitelyal tümör ve 5'inde (%4) melanom metastazı saptandı ve tümünde komplet (R0) rezeksiyon gerçekleştirildi. Ameliyat sonrası ortalama hastanede kalış süresi 5,4 (2-8) gün, morbidite oranı %6,3, mortalite oranı %1,6 idi. Epitelyal tümörler, sarkomlar ve melanomlar için ortanca sürvi 42, 27 ve 1...

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Who Actually Profits from Pulmonary Metastasectomy Operation? Retrospective Analysis of 12 Years

Evman¹,

Demirhan²,

Cardak³

et al. 2015

Eurasian J Pulmonol

View full text Add to dashboard Cite

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“…Forty-four percent of patients had viable tumour in the resected specimen, and 26% of patients had metastases to other sites. Overall 5-yr survival after pulmonary resection was 68%, but 82% for patients diagnosed after 1985, when cisplatin-based chemotherapy regimens for NSGCT were introduced (43). Persistent carcinoma in the specimen (p<0.0001), and concurrent metastases to non-pulmonary, visceral sites (p=0.0069) were negative prognostic factors.…”

Section: Germ Cell Tumoursmentioning

confidence: 99%

“…Surgical mortality is akin to pulmonary resection for other diagnoses (0-0.6%) (39,(41)(42)(43). A surgical mortality of <1% was reported in pulmonary metastatectomy in the Indiana University series (45).…”

Section: Complications and Concernsmentioning

confidence: 99%

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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“…However, if viable tumour cells are found, the patient requires additional chemotherapy. With the current multimodality strategy, a 5-year survival rate of up to 82% can be achieved (55). Multiple metastases, elevated tumour marker levels of alpha-fetoprotein or chorionic gonadotropin, or viable cells in the resected metastases after chemotherapy, negatively influence overall survival (12,45,46,56).…”

Section: Lung Metastasectomy For Different Histological Tumours 1 Brmentioning

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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Pulmonary metastasectomy for testicular germ cell tumors: A 28-year experience

Cited by 87 publications

References 22 publications

Who Actually Profits from Pulmonary Metastasectomy Operation? Retrospective Analysis of 12 Years

Who Actually Profits from Pulmonary Metastasectomy Operation? Retrospective Analysis of 12 Years

Results of Pulmonary Resection

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

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