Video-assisted thoracoscopic surgery versus open thoracotomy in pulmonary metastasectomy: a meta-analysis of observational studies

Abstract

VATS is an alternative surgical approach for pulmonary metastasectomy in patients with resectable pulmonary metastases. Further large prospective studies are needed to identify the indications for VATS in patients with pulmonary metastases.

Thoracoscopy vs thoracotomy for the management of metastatic osteosarcoma: A Pediatric Surgical Oncology Research Collaborative Study

“…Data comparing operative techniques for pulmonary metastasectomy in other tumor types suggest comparable outcomes but may not be transferable to osteosarcoma. A recent systematic review of metastasectomy in all tumor types found superior 5‐year overall and recurrence‐free survival with the thoracoscopic approach, 25 and a meta‐analysis published in 2015 showed similar results 26 . However, metastases from other sarcomas lack the calcification of osteosarcoma which allows for manual palpation at sizes below the resolution of CT.…”

“…A recent systematic review of metastasectomy in all tumor types found superior 5-year overall and recurrence-free survival with the thoracoscopic approach, 25 and a meta-analysis published in 2015 showed similar results. 26 However, metastases from other sarcomas lack the calcification of osteosarcoma which allows for manual palpation at sizes below the resolution of CT. pain, as well as shorter ICU and hospital stays. 13,16,[29][30][31] Notably, prior studies have demonstrated a profound difference in the risk of scoliosis after thoracotomy (54%) or thoracoscopy (9%), although the use of muscle-sparing techniques for thoracotomy may help to mitigate this risk.…”

Microcoil-Guided Video-Assisted Thoracoscopic Excision of Nodules Suspicious for Metastasis in Patients With Extra-Thoracic Malignancies

“…Colorectal adenocarcinoma was the most prevalent primary extra-thoracic cancer. The previously treated extra-thoracic malignancies were colorectal (16), breast (8), urogenital (7), sarcoma (5) All resected specimens included the microcoils which were confirmed with fluoroscopy during surgery and on x-rays postresection. Video-assisted thoracoscopic surgery wedge resection after CTML was successfully diagnostic in 98% of the patients.…”

“…15 Further, several metaanalyses confirmed no difference in survival between VATS and conventional thoracotomy for treatment of pulmonary metastases, making VATS a safe and feasible option. 16 Unfortunately, the initial management options of lung nodules in patients diagnosed with cancer are usually limited by lesion size. Small nodules cannot be reliably classified as benign or malignant using CT criteria or PET/CT scan analysis.…”

Lungenmetastasenchirurgie beim pulmonal metastasierten kolorektalen Karzinom

“…Zwar stellt die VATS das geringere Operationstrauma dar und führt im Vergleich mit der Thorakotomie zu einer statistisch signifikanten Reduktion postoperativer Komplikationen, der Thoraxchirurg muss jedoch fürchten, radiologisch nicht erkannte Lungenmetastasen zurückzulassen [8,27]. Im Gegensatz zu dieser Befürchtung legen aktuelle Studiendaten nah, dass die VATS das Gesamtüberleben, das krankheitsspezifische und das progressionsfreie Überleben im Vergleich zur Thorakotomie nicht signifikant reduziert [8,15,[27][28][29] [28]. Der Vergleich der operativen Zugangswege sollte zukünftig Gegenstand prospektiver Studien sein.…”