Surgical treatment of metastatic diseases to the lung

Abstract

Introduction: The problem of treating secondary cancer is very controversial. Huge progress in its treatment began in the 1970s with the introduction of chemotherapy. In the surgical aspect Pastorino's work published in 1997 was a milestone. To this day, most authors cite its research results. Aim: The task is to answer the question what tactics to follow in the surgical treatment of patients with secondary cancer affecting the respiratory system. Material and methods: Retrospective studies were conducted on a group of 577 patients. Men prevailed slightly. The average age was 56 years. Surgical access used in the vast majority of cases was anterolateral thoracotomy. Wedge resection was the most common scope of surgery. Lymph nodes were not removed as standard. Single and multifactorial statistical surveys were conducted (Kaplan-Meier estimator and multifactorial Cox regression analysis). Results: A total of 1,058 operations were performed during which 1889 metastases were removed. Negative tissue margins were obtained in 90.4%. The median survival was 47 months. Complications occurred in 76 patients, which constituted 7.1% of performed procedures. There were 3 perioperative deaths. Conclusions: It was found that the factors negatively affecting survival were lack of radicalism, size of the metastasis > 3 cm, and number of metastases > 1. The factors positively influencing survival were a longer time than primary surgery and a greater number of operations. Histological diagnosis differentiated patient survival.

Treatment outcomes of surgery and chemotherapy for pulmonary metastases from non-lung cancers: a propensity score-matched analysis

“…Further analysis revealed that the number and total diameter of metastases in the three subgroups were smaller than those in the other corresponding subgroup, and there was a significant difference in the total diameter of metastases between wedge resection and lobectomy (P<0.05). One study showed that the number and size of metastases significantly influenced prognosis (21). Therefore, we believe that better survival may be associated with a lower tumor load and not with differences in surgical treatment.…”

Identification of Metastatic Lymph Nodes Using Indocyanine Green Fluorescence Imaging

“…LN dissection is not a routine procedure for metastatic lung cancer [ 19 ]. However, the incidence of LN metastasis in this cancer ranges from 12 to 19%, and the negative impact of LN metastasis on survival has been demonstrated [ 17 ].…”

“…The 5-year survival rate is 58.3% in the absence of LN metastasis and 24.8% with metastasis [ 18 ]. However, LN assessment is not routinely performed for patients with lung metastasis [ 19 ]. Only suspicious LNs are dissected during lung metastasectomy [ 20 ].…”

The usefulness of progression-free survival in surgical treatment of lung metastases

“…In our research, the rate was around 7%, of which around 30% were not related to the surgery. The risk of perioperative death in the study group was 0.5% [ 3 , 4 ]. For the purposes of the present study, the PFS time was defined as the appearance of new lung lesions after metastasectomy or the date of death or the date of completion of the observation assuming that the patient was alive up to that date.…”

“…Here, too, often erroneous results of publications dealing with this problem are produced. In our previous studies, after creating two comparable groups of patients, we found longer survival in patients without relapse after metastasectomy (median survival 71 months without relapse versus 36 months with relapse) [ 3 , 4 ]. Subsequent metastasectomies are directly related to disease progression.…”