Laser-assisted Surgery Group Research Articles

Laser pulmonary metastasectomy preserves parenchyma: a single-centre retrospective study from the United Kingdom

BackgroundPulmonary metastasectomy (PME) is a modality increasingly employed to control oligometastatic disease from a variety of solid tumours.We present data from a single UK centre, following the introduction of laser-assisted surgery (LAS) using the Limax® 120 Nd:Yag laser (Gebrüder Martin GmbH & Co. KG, Tuttlingen, Germany).MethodsAll patients undergoing PME between September 2015 and August 2018 were included in our study. Those undergoing LAS were compared to a control of conventional stapled wedge metastasectomy (SWM). Data was analysed retrospectively from a prospective kept database. Statistical analysis was performed using JASP (Version 0.14.1).ResultsFifty-seven procedures in 46 patients, were included in the final analysis. Demographic data was similar at baseline between the LAS and SWM group, with colorectal cancer being the most common primary, 44/57 (77%). LAS was favoured in patients who had previously undergone pulmonary metastasectomy, 9/12 (75%). Patients in the LAS group had a smaller parenchymal volume resected (MD 30.6 cm3, p = 0.0084), with a lower incidence of clear histological marginal resection (11/27 vs 29/30, p < 0.0001); but no difference in operative time, morbidity, patient-reported outcome measures, or local recurrence between the two groups at 2 years. LAS was associated with a lower procedural cost (MD £452.92, p < 0.0001).ConclusionsLaser-assisted pulmonary metastasectomy presents a safe and acceptable alternative to traditional stapled wedge resection, with notable parenchymal-sparing, no discernible learning curve, and lower direct costs.

Pulmonary laser-assisted metastasectomy is associated with prolonged survival in patients with colorectal cancer.

Pulmonary metastases develop in 10-15% of patients with colorectal cancer. Surgical metastasectomy currently provides the only hope for a cure for these patients. The aim of this study was to analyze the expanding role of pulmonary metastasectomy in the context of laser-assisted surgery (LAS) vs. non-laser-assisted surgery (NLAS). We performed a single-center retrospective analysis of 204 patients who underwent curative pulmonary metastasectomy for colorectal cancer between 01/2005 and 12/2016. The main endpoint was survival. The Kaplan-Meier method was applied for statistical analysis and survival rates were compared with the log rank test. Median follow-up was 53 months. A total of 267 metastases were resected in 154 operations in the NLAS group (median: 1) vs. 438 metastases in 122 operations in the LAS group (median: 5; P<0.0001). The interval between treatment of the primary tumor and the first pulmonary metastasectomy was significantly shorter in the LAS group (19 vs. 32 months; P=0.008). Anatomical resections were significantly reduced using LAS, 8% vs. 23% respectively. Despite more negative predictors in the LAS group, there was no statistically significant difference in overall disease-specific 5-year survival (70% LAS vs. 58% NLAS; P=0.18). Survival after pulmonary metastasectomy has previously been shown to correlate with a low number of metastases and a longer disease-free interval. However, with the tissue-saving LAS technique complete resectability can be achieved in patients with more metastases and long-term survival is possible for selected patients.