The Number of Pulmonary Metastases: Influence on Practice and Outcome

Garcı́a-Yuste, Mariano; Cassivi, Stephen D.; Paleru, Cristian

doi:10.1097/jto.0b013e3181dcf787

Cited by 22 publications

(11 citation statements)

References 22 publications

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“…The "International Registry of Lung Metastases" suggests several prognostic factors: (1) a complete radical resection, (2) a DFI between the primary tumor and the development of metastases, and (3) the number of metastases. Prognosis generally decreases with the number of lesions [15,22,23].…”

Section: Long-term Resultsmentioning

confidence: 99%

Pulmonary metastasectomy

et al. 2011

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Background: The major obstacle in curing cancer is the limited ability to prevent and treat metastatic disease. Pulmonary metastasectomy is now a standard treatment option in carefully selected cases. With the lung being frequently the only site of metastasis, a complete resection of all tumor masses poses a potentially curative treatment option.Methods: This review article gives an outline of the basics of pulmonary metastasectomy and reviews the latest research in this field.Results and conclusions: Technical advances in thoracic surgery during the past decades made pulmonary metastasectomy a safe procedure with a low morbidity. However, surgical resection must be embedded in an individualized oncological concept.The beginnings of pulmonary metastasectomy can be traced back to the 19th century. The first case of a resection of pulmonary metastases was reported in 1882. Josef Weinlechner, a Viennese pediatric surgeon, accidentally discovered and resected two metastatic nodules in the lung when removing a large sarcoma of the thoracic wall [1]. Unfortunately, this first patient died the day after surgery from shock. Throughout the following decades, single case reports of pulmonary metastasectomy have been described in the literature. In most cases, the resection of pulmonary nodules led to long-term survival. As open chest surgery in those times was itself a life-threatening intervention, beneficial effects of metastasectomy were often restrained by the high mortality and morbidity of the surgical procedure. Since these early days of pulmonary metastasectomy, many advances have been made in surgical techniques and perioperative patient care. Consequently, pulmonary metastasectomy has developed into one of the major surgical procedures in thoracic surgery [2].

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Section: Long-term Resultsmentioning

confidence: 99%

Pulmonary metastasectomy

et al. 2011

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“…[167] The prognosis of patients with a single metastasis was significantly better than that of patients with the multiple metastases. [16] There is no clear standard for the minimum number of metastases necessary to undergo surgery. It is generally believed that surgical resection may be performed as long as the tumor can be completely removed and patients can physically tolerate surgery.…”

Section: Discussionmentioning

confidence: 99%

Surgical approach and outcomes for treatment of pulmonary metastases

Su¹,

Ma²,

Zhang³

et al. 2013

Ann Thorac Med

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AIMS:To investigate the surgical approach and outcomes, as well as prognostic factors for pulmonary metastasectomy.METHODS:Clinical data of 201 patients treated by pulmonary metastasectomy between January 1990 and December 2009 were retrospectively reviewed. One hundred thirty three patients were received an approach of thoracotomy while 68 with video-assisted thoracoscopic surgery (VATS). There were 54 lobectomies, 139 wedge resections and 8 pneumonectomies. Hilar or mediastinal lymph nodes dissection or sampling was carried out in 38 patients with lobectomy. The Kaplan-Meier method was used for the survival analysis. Cox proportional hazards model was used for multivariate analysis.RESULTS:The 5 years survival rate of patients after metastasectomy was 50.5%, and the median survival time was 65.9 months. The median survival time of patients with hilar or mediastinal lymph nodes metastasis was 23 months. By univariate analysis, significant prognostic factors included disease-free interval (DFI), number of metastases, number of affected lobe, surgical approach (open vs. VATS) and pathology types. DFI, number of metastases, and pathology types were revealed by Cox multivariate analysis as independent prognostic factors.CONCLUSION:Surgical resection of pulmonary metastases is safe and effective. Palpation of the lung is still seen as necessary to detect the occult nodule. More accurate and sensitive pre-operative mediastinal staging are required.

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“…Thirty-one patients (35.6 %) live without progression of the disease after resection of metastases, and the median DFI is 15 months (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In total, 34 % and 28 % of patients survived without any signs of relapse or progression of the disease for three years and 5 years, respectively (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…malignant melanoma, esophageal cancer, breast cancer, etc.) the authors actually do not arrive at consensus because some of them do not recommend metastasectomies of multiple metastases of these tumors due to poor prognosis, especially with short DFI from the surgery of primary tumor, while the other part of authors prefer a more radical approach of indicating surgery regardless of DFI and number of metastases (10,11,12,13,14). The cases which include metastasectomies of synchronous metastases and elevation of oncological markers are considered as arguable by some authors because of a quite poor prognosis (14,15).…”

Section: Discussionmentioning

confidence: 99%

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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The Number of Pulmonary Metastases: Influence on Practice and Outcome

Cited by 22 publications

References 22 publications

Pulmonary metastasectomy

Pulmonary metastasectomy

Surgical approach and outcomes for treatment of pulmonary metastases

Surgical therapy of pulmonary metastases – 10-year results

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