Pulmonary Resection for Metastatic Gastric Cancer

Abstract

IntroductionPulmonary metastasectomy has come to be recognized as an effective treatment for selected patients with colorectal cancer, renal cancer and other malignancies, and in recent years, long-term survival after pulmonary metastasectomy has been reported in patients with several malignancies. [1][2][3] On the other hand, the role of pulmonary metastasectomy in gastric cancer patients with pulmonary metastasis is still unclear.The prognosis of patients with metastatic gastric cancer is poor. The median survival after diagnosis of pulmonary metastasis is 4 months, and even in patients treated by chemotherapy, the reported 5-year survival is only 2%-4%. [4][5][6] Recently, several studies have revealed relatively good surgical outcomes, and the role of pulmonary metastasectomy is becoming clearer. [7][8][9] In this study, we reviewed the clinicopathological features of 10 patients who underwent pulmonary metastasectomy for gastric cancer, and examined the outcomes and prognostic factors affecting the survival of the patients after the pulmonary metastasectomy. Pulmonary Resection for Metastatic Gastric CancerYoshihito Iijima, MD, PhD, 1 Hirohiko Akiyama, MD, PhD, 1 Maiko Atari, MD, 1 Mitsuro Fukuhara, MD, 1 Yuki Nakajima, MD, PhD, 1 Hiroyasu Kinosita, MD, PhD, 1 and Hidetaka Uramoto, MD, PhD 1,2Background: Pulmonary metastasectomy has come to be recognized as an effective treatment for selected patients with some malignancies. On the other hand, the role of pulmonary metastasectomy for gastric cancer is still unknown. Metastasectomy is rarely indicated in cases of pulmonary metastasis from gastric cancer, because in most cases, the metastasis occurs in the form of lymphangitic carcinomatosis and the lesions are numerous. The purpose of this study was to determine the surgical outcomes and prognostic factors for survival after pulmonary metastasectomy. Methods: From 1985 to 2012, 10 patients underwent pulmonary metastasectomy for gastric cancer at Saitama Cancer Center, Japan. The overall survival rate was examined by the KaplanMeier method and univariate analysis was carried out to identify prognostic factors. Results: The overall 3-year survival rate was 30.0%. The median follow-up period was 26.8 months (range, 6.5-96.6) after the pulmonary metastasectomy. Univariate analysis revealed an advanced pathological stage of the gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy as unfavorable prognostic factors. Conclusion: Pulmonary metastasectomy should be considered in selected patients with lung metastasis from gastric cancer. An advanced pathological stage of gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy are unfavorable prognostic factors.

Surgical treatment of stage IV gastric cancer: is it worthwhile?

“…Figure 1 shows the study search strategy. Overall, 39 studies were included in the final review (26 for hepatic resection , 4 for pulmonary resection [44][45][46][47] and 9 for palliative gastrectomy [48][49][50][51][52][53][54][55] ).…”

“…Overall survival outcomes are summarized in Table 3. Iijima et al [46] reported an overall 3-year survival rate of 30%. Kobayashi et al [47] showed a median survival time following pulmonary resection of 67 months and an overall 5-year survival rate of 59%, while Shiono et al [44] reported a value of 28%.…”

“…Overall 39% of patients underwent lobectomy, while wedge resection or segmentectomy was performed in 61%. In 3 studies [45][46][47] , indications for performing surgery were decided based on Thomford's criteria [57] . Shiono et al [44] did not specify the criteria for surgical resection.…”

Prognostic value of the site of distant metastasis and of surgical interventions in metastatic gastric cancer: a population-based study

“…Besides, the present study also revealed that patients with single-site lung metastasis exhibited a favorable prognosis following resection of the metastatic lesion. Several retrospective studies reported a survival rate of nearly 30% at 5-years and improved prognosis for patients with advanced GC who underwent lung metastasis resection [30][31][32]. However, Sun et al suggested that the primary resection of GC with lung metastasis had no significant survival benefit [33].…”

Long-term survival after pulmonary resections for multiple metastases from gastric cancer: A case report

“…Recently, several reports have been published concerning favorable prognostic factors of pulmonary resection for gastric cancer. Iijima et al reported that early pathological stage of gastric cancer and absence of extrapulmonary metastasis were favorable prognostic factors [ 9 ]. Shiono et al reported that relatively good surgical outcome could be expected for patients with disease-free intervals longer than 12 months, and their observed 5-year survival rate of pulmonary metastasectomy was 28% [ 10 ].…”