Role Of Pulmonary Metastasectomy Research Articles

Long-term survival after pulmonary metastasectomy in patients with esophageal squamous cell carcinoma with lung metastasis

ObjectivesEsophageal squamous cell carcinoma with pulmonary metastasis has a poor prognosis, and the only treatment modality is systemic therapy such as chemotherapy. Previous studies showed that pulmonary metastasectomy may provide benefits and has been suggested in selected patients with colorectal cancer, renal cancer, and sarcoma. However, there were few literatures evaluating the impact and treatment outcome of pulmonary metastasectomy in esophageal squamous cell carcinoma patients with isolated lung metastases. Therefore, we conducted this study.MethodsWe retrospectively reviewed our patients with esophageal squamous cell carcinoma with pulmonary metastasis. Patients with extrapulmonary metastasis were excluded. We categorized them into two groups - the pulmonary resection group and the systemic treatment only group. We compared the overall survival and progression-free survival between groups, and also analyzed the surgical modality, which includes single or multiple port surgery.ResultsThe analysis included 44 esophageal squamous cell carcinoma patients with lung metastasis. Among these 44 patients, 14 patients have received pulmonary metastasectomy, and 30 patients received systemic treatment only. Patients who received pulmonary metastasectomy had significantly better overall survival (p < 0.0001) and progression-free survival (p = 0.038) than those who received only systemic treatment. The one-year overall survival and progression-free survival were 100% and 48% in patients receiving pulmonary metastatectomy, and 49% and 33% in patients receiving only systemic treatment. Among 14 patients receiving pulmonary metastatectomy, 10 patients underwent single port surgery. There were no postoperative complications in these 14 patients.ConclusionEsophageal squamous cell carcinoma patients with lung metastasis who can receive pulmonary metastasectomy have better prognosis, and some patients can achieve long-term survival. Our findings suggest that aggressive pulmonary metastasectomy is suggested in esophageal squamous cell carcinoma patients with if no contraindication.Visual Key question: How about the role of pulmonary metastasectomy in esophageal squamous cell carcinoma patients with isolated lung metastasis?Key findingsPatients who received pulmonary metastasectomy had better overall survival and progression-free survival than those who received only systemic treatment.Take Home MessageEsophageal cancer with isolated pulmonary metastasis can be treated aggressively with pulmonary metastasectomy if no contraindication.

Clinical Value of Pulmonary Metastasectomy for Thyroid Malignancies: A Systematic Review

Background:There is currently no consensus on the role of pulmonary metastasectomy(PM) for thyroid malignancies. The main objective of this study is therefore to systematically determine if there is any survival benefit to PM and determine good candidates for metastasectomy.&#x0D; Methods: A systematic review of relevant studies was performed, evaluating articles identified using the PubMed, Cochrane and MEDLINE databases according to PRISMA-guidelines.&#x0D; Results:The initial literature search yielded 18 articles of which 7 met inclusion criteria. Only data on thyroid cancers were included in the systematic review. A total of 174 patients who underwent PM were analyzed. The mean age was 54.8(range: 10-90), and 52.5% of patients were female. The overall absolute 5-year survival rate was 67.7% (range: 32.5-84.0%) for patients undergoing PM. The reported post-surgical complication rate overall was 14.4% and two peri-operative deaths were reported. Three papers reported the following as good prognostic factors: Papillary histology, younger age(&lt;45), disease free interval&gt;3 years, R0 resection, systematic lymphadenectomy, thyroglobulin &lt;10 ng and thyroglobulin reduction &gt;80% after metastasectomy.&#x0D; Conclusion:This study is the first systematic review evaluating the clinical role of PM for thyroid cancer in the literature to date. PM may offer prolonged survival over traditional therapy for selected patients.

Prognostic Analysis of Surgical Resection for Pulmonary Metastasis from Hepatocellular Carcinoma.

Pulmonary metastases are the most common among extrahepatic recurrences from hepatocellular carcinoma (HCC). It causes high risk of HCC-related death, despite recent progress in therapeutic options. However, a role of pulmonary metastasectomy as well as prognostic factors after metastasectomy has not been well established. We aimed to investigate survival outcomes and prognostic factors after pulmonary resection for metastases from HCC. A series of 93 patients who underwent pulmonary resections for metastases from HCC between June 1990 and July 2013 from multi-institutional database were retrospectively evaluated. Perioperative clinicopathological data and their association with prognosis were investigated. Of 93 patients, 77 had one pulmonary metastasis, and 16 had two or more. Recurrence after pulmonary resection was noted in 60 patients (64.5%). The estimated 5-year overall survival rate was 41.4% with median survival time after pulmonary metastatectomy of 39.0months. Univariate prognostic analysis showed that disease-free interval of ≥12months was significantly associated with favorable outcomes in both overall survival (5-year rate, 59.3 vs. 28.7%, p=0.026) and disease-specific survival (5-year rate, 62.5 vs. 36.2%; p=0.038) after pulmonary metastatectomy. A multivariate analysis revealed that disease-free interval was an independent prognostic factor (HR=2.020, 95% CI, 1.069-3.816, p=0.030). We have shown that a disease-free interval was an independent prognostic factor in patients who underwent pulmonary resection for metastasis from HCC. Also, pulmonary metastasectomy can be one of the therapeutic choices for select patients.

652 Role of pulmonary metastasectomy in patients with metastatic urothelial carcinoma

652 Role of pulmonary metastasectomy in patients with metastatic urothelial carcinoma

Pulmonary metastasectomy: role of pulmonary metastasectomy and type of surgery.

Patients with untreated metastatic disease have a less than 5 % to 10 % 5-year survival, and for the patient who has metastatic disease isolated to the lungs, pulmonary metastasectomy remains the best hope for cure. Pulmonary metastasectomy has been performed for decades. However, despite hundreds of studies spanning several decades, randomized control data in support of pulmonary metastasectomy is still lacking, and the evidence upon which we base this commonly accepted surgical practice is for the most part weak. While well-accepted surgical selection criteria exist, controversies related to pulmonary metastasectomy abound. Unanswered and clearly debatable are questions related to: optimal preoperative imaging, if mediastinal staging should be performed and if so when, is video-assisted thoracic surgery (VATS) equivalent to open thoracotomy, is finger palpation of the lung mandatory, is repeat pulmonary metastasectomy justified, and what is the interrelationship of pulmonary metastasectomy to other treatments. Current practice to the surgical approach to pulmonary metastasectomy remains quite variable.

Result of Surgical Resection for Pulmonary Metastasis from Urothelial Carcinoma

BackgroundTreatment of pulmonary metastasis from urothelial cell carcinoma has been mostly palliative chemotherapy and the role of pulmonary metastasectomy has not been investigated much.Materials and MethodsThis study is a retrospective interim review of pulmonary metastasectomy from urothelial carcinoma at single institution between 1998 and 2010. Overall 16 patients underwent pulmonary metastasectomies.ResultsThere was no postoperative complication or hospital mortality. Mean hospital stay was 6 days. Overall and disease-free 5-year survival were 65.3% and 37.5%, respectively.ConclusionIn selected patients with pulmonary metastasis from urothelial carcinoma, surgical treatment is feasible and could contribute to long-term survival in selected patients.

The role of pulmonary metastasectomy in stage IV adrenocortical carcinoma

The role of pulmonary metastasectomy in stage IV adrenocortical carcinoma

The prognostic factors for the recurred breast cancer patients with isolated, limited number of lung metastasis, and the implication of pulmonary metastasectomy

1112 Background: In recurred breast cancer (BC) with isolated lung metastasis, the role of pulmonary metastasectomy (PM) is not established. Methods: We consecutively enrolled recurred BC patients (pts) with isolated lung metastasis from 1997 to 2007 in Seoul National University Hospital. Among 140 recurred pts with isolated lung metastasis, 45 had metastatic lesions less than 4. We analyzed the clinical outcomes of these 45 pts. Results: The median age was 49.0 (range 32–67) years. The median disease-free interval (DFI, Time from initial BC diagnosis to recur) was 26.1 (range 4.2–168.0) months, and the pts with DFI of less than 24 months were 20 (44%). The pts who had biologic subtypes (BS) of hormone receptor (HR)(+), HER-2(+), triple negative (TN) were 16 (36%), 14 (31%,) and 15 (33%), respectively. Fifteen (33%) had PM then followed by systemic treatment (PM group), and 30 received systemic treatment without PM (no PM group). There was no difference in terms of clinical factors such as DFI and BS between two groups. The median progression-free survival (PFS) and overall survival (OS) were 13.0 months (95% CI, 10.05–15.95) and 41.7 months (95% CI, 23.82–59.58), respectively. In univariate analysis, PFS was significantly longer in pts with PM (p &lt; 0.001), DFI of more than 24 months (p &lt; 0.001), and was marginally significant according to BS (p = 0.084). In multivariate analysis, DFI of less than 24 months (hazard ratio [H], 4.53; 95% CI, 1.72–11.90), no PM (H, 9.52; 95% CI, 3.34–27.18) and BS such as HER-2(+) (H, 3.00; 95% CI, 1.04–8.64) and TN (H, 3.92; 95% CI, 1.32–11.59) were independent prognostic factors for shorter PFS. In univariate analysis, OS was significantly longer in pts with PM (p = 0.011), DFI of more than 24 months (p &lt; 0.001), HR(+) BS (p = 0.009). In multivariate analysis, DFI of less than 24 months (H, 7.67; 95% CI, 2.00–29.43) and BS such as HER-2(+) (H, 3.70; 95% CI, 1.03–13.24) and TN (H, 3.27; 95% CI, 1.02–10.44) were independent prognostic factors for shorter OS. Conclusions: In recurred BC with isolated, limited number (less than 4) of lung metastasis, DFI and BS were prognostic factors for PFS and OS. PM also prolonged PFS, and, for OS, more follow-up is needed. Further prospective studies to define the role of PM are warranted. No significant financial relationships to disclose.

The role of pulmonary metastasectomy in soft tissue sarcoma

Pulmonary metastases are common in patients with soft tissue sarcoma. The majority of patients who develop pulmonary metastases are asymptomatic and are diagnosed during routine follow-up visits. There is evidence to suggest that pulmonary metastasectomy is associated with improved overall survival but only in patients with complete surgical resection. There are several criterion to identify patients for resection. The majority of resectable patients have peripheral lesions that are amenable to wedge resection. There is little evidence to suggest that chemotherapy improves survival. Future research is needed to better identify patients for metastasectomy, to determine the role of minimally invasive procedures, and to develop better adjuvant therapy. Copyright 2002, Elsevier Science (USA). All rights reserved.

Pulmonary metastasectomy for soft tissue sarcomas: is it justified?

The role of pulmonary metastasectomy for metastatic soft tissue sarcomas is examined by reviewing the recent (1978-1994) English language literature. There are no prospective studies that contain an appropriate control group, and only one retrospective study contains a matched control group. In those few studies that provide greater than 5-year survival data, the survival curve still has a steep slope and few patients are alive at 7 years. In most studies only one or two patients are at risk at 5 years or more. Projected survival is therefore statistically questionable. It is currently impossible to know what is the impact of the surgical procedure over and above the natural history (biology) of the tumor. A randomized, prospective study, as suggested a decade ago, is still needed. While there may be some merit to pulmonary metastasectomy in highly selected patients, aggressive pulmonary metastasectomy does not seem justified by the available data.