Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness?: Table 1

Abstract

Pulmonary metastasectomy is a commonly performed operation and is tending to increase as part of a concept of personalised treatment for advanced cancer. There have been no randomised trials; belief in effectiveness of metastasectomy is based on registry data and surgical follow-up studies. These retrospective series are comprised predominately of solitary or few metastases with primary resection to metastasectomy intervals longer than 2–3 years. Five-year survival rates of 30–50% are recorded, but as case selection is based on favourable prognostic features, an apparent association between metastasectomy and survival cannot be interpreted as causation. Cancers for which lung metastasectomy is used are considered in four pathological groups. In non-seminomatous germ cell tumour, for which chemotherapy is highly effective, excision of residual pulmonary disease guides future treatment and in particular allows an informed decisions as to further chemotherapy. Sarcoma metastasises predominately to lung and pulmonary metastasectomy for both bone and soft tissues sarcoma is routinely considered as a treatment option but without randomised data. The commonest circumstance for lung and liver metastasectomy is colorectal cancer. Repeated resections and ablations are commonplace but without evidence of effectiveness for either. For melanoma, results are particularly poor, but lung metastases are resected when no other treatment options are available. In this review, the available evidence is considered and the conclusion reached is that in the absence of randomised trials there is uncertainty about effectiveness. A randomised controlled trial, Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), is in progress and randomised trials in sarcoma seem warranted.

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

“…Even when a lesion appears to be either malignant or benign on radiography, histological specimens should confirm the final diagnosis [7]. Preoperative diagnosis is in fact standard practice but is also a mandatory to include patients in prospective randomized trial that have the goal to demonstrate the effectiveness of lung biopsy for metastasis [8][9][10][11].…”

Pulmonary metastasectomy for colorectal cancer: analysis of prognostic factors affecting survival

“…Different prognostic factors including a short diseasefree interval between primary tumor resection and lung metastases occurrence, multiple metastatic nodules, and elevated preoperative CEA have been found to be associated with poor survival (7,8). Conversely, the presence of synchronous or metachronous resected liver metastases was not significantly related to poor survival (7).…”

Uniportal non-intubated lung metastasectomy

“…M, man; F, female. Drainage removal (hours) 14 Postoperative pain at 1 hour (VAS 1-10) 5 [2][3][4][5][6] Postoperative pain at 24 hours (VAS 1-10) 3 [1][2][3][4] Hospital stay (days) 3 [2][3][4] Major morbidity rate 5.6% (4/67)…”

“…One hour after surgery, the patient himself is able to evaluate the postoperative recovery by the Quality of Recovery (QoR-40), which is a 40-item self-administered questionnaire (19). Each item is linked to a 5-point Likert scale [1][2][3][4][5] with a minimum cumulative score of 40 (global maximal impairment) and maximum of 200 (no impairment).…”

“…The surgical resection of lung metastases is still considered a reliable therapeutic option in patients with pulmonary oligometastases (1). These lesions are mostly peripherally located and seem to be ideal target for a video-assisted thoracoscopy (VATS) (2,3) despite the impossibility of manual palpation (4,5).…”