Surgery For Pulmonary Metastases Research Articles

Surgery for Pulmonary Metastases: Long-Term Survival in 281 Patients.

Despite weak evidence, pulmonary metastasectomy (PM) is widely performed with intent to improve patient survival. Our single-institution analysis aims to evaluate outcomes and to identify factors influencing survival of patients undergoing PM for metastases from wide range of primary tumors. All patients undergoing curative-intent PM between 2008 and 2018 were retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on overall survival (OS) was evaluated using univariable and multivariable Cox proportional hazard models. Cutoff values of continuous variables were determined by a receiver operating characteristic analysis. In this study, 281 patients (178 male, median age 61 years) underwent PM. Two (0.7%) perioperative deaths and 23 (8.2%) major complications occurred. Median interval between the treatment of primary tumor and PM was 21 months. Median size of largest metastasis was 1.4 cm. After the median follow-up of 29 months, 134 patients (47.7%) had died. Five-year OS rate after first PM was 47.1%. Complete resection was achieved in 274 (97.5%) patients. Multivariable analysis identified genitourinary origin (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.15-0.60, p = 0.0008) as independent positive survival prognosticator; incomplete resection (HR: 3.53, 95% CI: 1.40-8.91, p = 0.0077) and age at PM of ≥66 years (HR: 1.97, 95% CI: 1.36-2.85, p = 0.0003) were negative prognosticators. The use of PM as a part of multimodal treatment is in selected population justified. Our analysis identified age, primary tumor origin, and completeness of resection as independent survival prognosticators.

Segmentectomy by video-assisted thoracic surgery for pulmonary metastases

Segmentectomy by video-assisted thoracic surgery for pulmonary metastases

P2.15-04 Impact of Prognostic Nutritional Index on Long-Term Outcomes After Surgery for Pulmonary Metastasis from Colorectal Cancer

P2.15-04 Impact of Prognostic Nutritional Index on Long-Term Outcomes After Surgery for Pulmonary Metastasis from Colorectal Cancer

Progress in Surgery for Pulmonary Metastases

肺是除肝脏以外肿瘤最常见的转移部位，肺转移瘤切除术也是目前胸外科常规手术之一。然而肺转移瘤切除术的临床效果尚存争议，但就目前的临床经验，无瘤间隔时间长、原发肿瘤恶性程度低、转移瘤可被完全切除的肺转移瘤患者行肺转移瘤切术获益最大。本文就肺转移瘤的外科治疗进展进行综述回顾。

RESULTS OF PULMONARY METASTASES RESECTION WITH THE ND: YAG LASER AND ELECTROCAUTERY

Purpose. To assess the effectiveness of various techniques of surgery of pulmonary metastases based on the outcomes of surgery interventions, frequency of postoperative complications and overall survival of patients.Patients and methods. Ninety-seven patients with suspected lung metastases of known primary malignancies (47 men and 50 women, mean age of 46,5 years) were retrospectively included in two study groups between 1 January 2004 and 1 January 2016 and underwent pulmonary surgery with the Nd: YAG laser of the 1318 nm wavelength (Group A, n = 44) or with the electrocautery (Group B, n = 53).Results. A total of 151 operations were performed: 75 in Group A, 76 in Group B. The mean number of resected pul­monary lesions was 8,2 (95% CI: 5,2–11,1) in group A and 4,9 (95% CI: 3,7–6,0, p = 0,047) in group B. Additionally 87 lesions were evaporated due to small sizes (1–2 mm) in Group A. The mean time of surgery was 146 minutes in Group A and 113 minutes in Group B (p < 0,01).Post-surgery complications were diagnosed after 9 and 19 of interventions in Groups A and B, respectively. The most common complications were pneumonia, pneumothorax and subcutaneous emphysema. The number of Grade III com­plications according to Clavien-Dindo classification was 2 and3 inGroups A and B, respectively. The survival rates were computed for all patients: the one-year, three-year and five-year survival rates were 83,7%, 49,7% and 36,7%, respec­tively.Conclusion. The Nd:YAG laser with wavelength of 1318 nm allow extensive parenchymal resections without an increase in post-surgery complications and may have advantages in pulmonary metastasectomy, especially in patients with mul­tiple pulmonary lesions.

Surgery for pulmonary metastases from colorectal cancer: survival and prognostic factors

This study aimed to describe overall survival following pulmonary metastasectomy for colorectal cancer (CRC) in Sweden, and to assess the discrimination of a recently proposed risk prediction model. Individual-level data of 756 patients who underwent resection of pulmonary metastases from CRC between 2009 and 2015 were obtained from ThoR, a Swedish national quality register for thoracic surgery. We classified patients into three risk categories according to the number of preoperative risk factors [age, disease-free interval (DFI), presence of extrathoracic lesions, number of pulmonary metastases] established in a prior study. We estimated the hazard ratios (HRs) and 95% confidence interval (CI) by Cox regression and the restricted mean survival time difference as group contrast measures. During a median follow-up time of 2.9 years, 35% (268/756) patients died. At 5 years, overall survival was 56% (95% CI: 51-60%). In a Cox regression model with risk category as the only independent variable, the HR for all-cause mortality was 1.94 (95% CI: 1.38-2.72, P<0.001) and 4.35 (95% CI: 2.49-7.62, P<0.001) in the moderate- (n=558) and high-risk categories (n=32), respectively, versus the low-risk category (n=166). At 5 years, the differences in restricted mean survival time were 6 months (P<0.001) and 1.5 years (P<0.001) in the moderate- and high-risk categories, respectively, versus the low-risk category. Five-year survival after surgery for pulmonary metastases from CRC in Sweden was similar or higher compared with contemporary reports. A prognostic model, initially developed in Japanese patients, had excellent discrimination in an external validation cohort of Swedish patients.

Long-term survival after surgery for pulmonary metastases from colorectal cancer: an observational cohort study.

Evidence for pulmonary metastasectomy following colorectal cancer (CRC) is scarce. The aim of the study was to investigate long-term survival and identify prognostic factors to aid patient selection. We included all patients who underwent pulmonary resections for CRC metastases between January 01, 2004 and December 31, 2015 in a population-based cohort study. The primary outcome measure was all-cause mortality and was ascertained from Swedish national registers. The Kaplan-Meier estimator was used to calculate cumulative survival. We used Cox regression for estimation of hazard ratios (HR) and 95% confidence intervals (CI) for the association between patient characteristics and survival. We included 184 patients. The number of procedures per year increased from 1 in 2004 to 34 in 2015. During a median follow-up time of 3.2 years, 36% (66/184) patients died. Overall survival at 5 years was 60% (95% CI: 50-68%) and was significantly lower compared to an age- and gender-matched Swedish population. Carcinoembryonic antigen (CEA) level was identified as a prognostic factor for mortality in the age and sex-adjusted analysis (HR, 2.46; 95% CI: 1.15-5.26, P=0.020). We found a steady increase in the number of pulmonary metastasectomies after CRC during the study period. We identified prethoracotomy CEA level as a prognostic factor for long-term survival, which was consistent with prior reports. The 5-year overall survival rate in our study was 60%, which was high in comparison with prior reports. Although our results indicated that current patient selection criteria were reasonable, definitive evidence of efficacy is pending.

Systematic review on awake surgery for lung metastases

In recent years, some authors started an awake surgery program for lung metastasectomy. Very few information are available, and there have been no randomized trials. Taking a cue from a clinical scenario a review on PUBMED was conducted from January 2000 to July 2017. The Following search terms were used to retrieve potentials published articles: “awake surgery” or “awake lung surgery” or “awake surgery for lung metastasectomy” or “non-intubated lung metastasectomy” or “awake surgery for pulmonary metastasectomy” or “non-intubated pulmonary metastasectomy” or “awake surgery for lung metastases” or “non-intubated lung metastases” or “awake surgery for pulmonary metastases” or “non-intubated pulmonary metastases”. Literature search yielded 5,295 studies, of which only 3 fulfilled our inclusion criteria, but only 2 studies presented statistical analysis for the survival and they were from the same group. Awake surgery for LM is a possible choice for selected patients when the general anesthesia or the intubation is contraindicated. Although there is “some encouraging” evidence regarding awake LM, its quality is still very weak to confirm the effectiveness for this approach. The initial positive results can drive further research in this direction, but caution is necessary.

Video-assisted thoracoscopic surgery (VATS) lower lobe bisegmentectomy (S7/8) for a central pulmonary metastasis.

Surgery for pulmonary metastasis is performed heterogeneously with regard to surgical approach [open vs. video-assisted thoracoscopic surgery (VATS)] and resection techniques (e.g., laser enucleation, electro-cautery resection, stapling). Complete tumor resection and preservation of lung parenchyma are of upmost importance. This is technically challenging, especially for central lesions close to vascular and bronchial segmental structures. Thus, simple thoracoscopic wedge resections are often not feasible. A VATS lower lobe bisegmentectomy (S7/8) was performed on a 62-year-old patient with a suspicious pulmonary nodule and a history of hemicolectomy for colorectal carcinoma. Different VATS techniques of vessel dissection and parenchymal control were applied. VATS anatomic segmental resections represent a helpful tool in surgical therapy of central pulmonary metastasis.

Frequency of unplanned surgical intervention in patients with stage IV colorectal cancer receiving palliative chemotherapy: An analysis of SEER-Medicare.

640 Background: Patients (pts) with synchronous stage IV colorectal cancer commonly begin palliative chemotherapy while the primary tumor remains. Single institution series report low rates of surgical intervention, but this has not been examined nationally. The present study utilizes a large national dataset to examine the natural history of unplanned surgical intervention in stage IV colorectal cancer pts on palliative chemotherapy. Methods: SEER-Medicare was queried for pts with metastatic colorectal cancer (1998-2009) who underwent resection or diversion (ICD9 procedure/CPT). The cohort was separated into 3 groups: elective (surgery on admission without urgent/emergent flag), urgent (surgery not on day of admission but within hospitalization or with urgent flag) and emergent (emergent flag). Pts who underwent any procedure for curative intent (elective colorectal surgery, liver directed therapy or surgery for pulmonary metastases) at any time were excluded. Demographics, tumor grade and comorbidities were analyzed for effect on intervention rate. Time to event for either urgent or emergent surgical intervention or censorship by death, were measured. Conditional analyses were performed to determine the risk of surgical intervention at 6 months, 1 and 2 years post diagnosis. Results: 3,992 pts met inclusion criteria. Median age=73; 53% male. White 79%, black 11% and other 10%. The overall intervention rate was 6%; 35% emergent, 65% urgent. At 42 months, 90% of the pts had died. The probability of requiring unplanned surgery between 6-12 months was 2.5%; 12-24 months=1.9%, and &gt;24 months=0.8%. Charlson comorbidity score of 1 was a significant predictor of surgical intervention (HR 1.64 [1.24, 2.19]). Sex, age and race had no influence on the likelihood of surgical intervention. Conclusions: This study represents a large series of stage IV colorectal cancer pts and the frequency of unplanned surgery in pts receiving palliative chemotherapy. Pts treated with palliative chemotherapy are unlikely to require urgent or emergent surgery, and therefore prophylactic surgery to reduce the risk of perforation or obstruction should not be routinely performed.

Video-Assisted Thoracoscopic Pulmonary Metastasectomy in Patients with Colorectal Cancer: A Recent 10-Year Single-Institution Experience.

The purpose of this study was to identify independent unfavorable prognostic factors for patients who underwent video-assisted thoracoscopic surgery for resection of pulmonary metastases from colorectal cancer (CRC). Between January 2004 and December 2013, 131 patients with pulmonary metastases from CRC underwent the aforementioned procedure for the first time at our institution. Kaplan-Meier survival curves and log-rank tests were used to analyze the survival rates. Multivariate analyses were performed using the Cox proportional hazards regression model. The 5-year disease-free survival (DFS) rate of these 131 patients was 34%. Multivariate analyses showed two variables to be independent significant unfavorable prognostic factors for DFS: preoperative high serum carcinoembryonic antigen (CEA) level and a greater number of pulmonary metastases. According to subgroup analyses that combined these two risk factors, the 5-year DFS rates were 58, 25, and 12% for patients with 0, 1, or 2 risk factors, respectively. In patients who underwent video-assisted thoracoscopic surgery for pulmonary metastases from CRC, we identified two independent unfavorable prognostic factors for DFS: a high CEA level before metastasectomy and a greater number of pulmonary metastases. These factors can be used to identify higher- and lower-risk subgroups, which may help with selecting patients who would benefit the most from video-assisted thoracoscopic pulmonary metastasectomy.

Solitary pulmonary metastasis of pancreatic cancer presenting a thin-walled cavity

Because the prognosis of the patients with pancreatic cancer is very poor, there are few opportunities to perform surgery for pulmonary metastasis. Here we report the resection of a solitary pulmonary metastasis from pancreatic cancer, appearing as thin-walled cavity, which appeared 5 years after pancreaticoduodenectomy. Although the present patient underwent incomplete resection because of malignant pleural effusion and pleural dissemination, he is currently still alive without evident recurrence at 18 months after surgery.

Incidence and Predictive Factors for Pulmonary Metastases After Curative Resection of Colon Cancer

To assess the actuarial incidence of pulmonary metastases as the first site of metastasis after R0 resection of colon cancer and to clarify predictive factors for pulmonary metastases as the first site of metastasis. Data for 746 patients who underwent R0 resection for colon cancer from 2000 to 2006 were reviewed. The mean duration of follow-up was 56.9months. Pulmonary metastases developed in 35 patients. Mean duration from colon surgery to identification of pulmonary metastases was 20.0months. The overall occurrence rates of 5-year pulmonary metastasis according to Union for International Cancer Control (UICC) stage were 0.6% (stage I), 2.2% (stage II), 9.8% (stage III), and 24.6% (stage IV), respectively. Surgery for pulmonary metastases was performed first 18 patients (51.4%), and 16 (88.9%) of these 18 patients achieved R0 surgery. Multivariate analysis revealed that presence of regional lymph node involvement and preoperative serum carcinoembryonic antigen level (≥5ng/ml) were significant independent risk factors for pulmonary metastases. Five-year actuarial incidence of pulmonary metastases increased significantly with increased number of risk factors (0 factors, 2.2%; 1 factor, 6.6%; 2 factors, 18.4%). The present study clearly demonstrated predictive factors for pulmonary metastases after R0 resection of colon cancer. Actuarial incidence of pulmonary metastases was significantly related to the number of risk factors present. The data should facilitate the establishment of novel algorithms for predicting pulmonary metastases after resection of colon cancer, which may lead to the appropriate surveillance strategies after colon surgery.

Analysis of prognostic factors and treatment of pulmonary metastasis from colorectal cancer

To investigate effect of the treatments and prognostic factors of patients with pulmonary metastasis from colorectal cancer. Clinical data of 79 patients who suffered from lung metastatic diseases from colorectal cancer in 1990 - 2010 were retrospectively analyzed. The number of patients who had received lung operation was 22, and non-operated group contained 57 patients. Compared the prognosis of operated group and non-operated group and analyzed the prognostic factors. The median survival time after the pulmonary resections was 34.5 months; the overall survival of 1-, 3- and 5-year survival rates were 90.9%, 45.4% and 4.5%, and the overall of 1-, 3-, and 5-year survival rate in non-operated group were 59.6%, 14.0% and 0. The surgery (RR = 4.805, 95% CI: 1.864 - 12.384, P = 0.001) and the number of metastasis (RR = 2.177, 95% CI: 1.431 - 3.314, P = 0.010) were the factors that could influence the patients prognosis. The surgery for pulmonary metastases from colorectal cancer is effective.

Surgery of Pulmonary Metastases: Series of 85 Patients

Introduction: Lung metastases are the second leading cause of lung resection, constituting 30-40% of all surgeries performed in the field of Thoracic Surgery. Resection of pulmonary metastases is an open issue that generates various controversies. Depending on the functional respiratory capacity of the pulmonary metastatic patient, may come to consider multiple surgeries in the same patient, as many as the patient is able to tolerate by his or her respiratory reserve. Goal: Study of the results from surgical resection of pulmonary metastases in general and in particular those of colorectal origin. Patients and methods: Descriptive and observational retrospective study of 85 patients with pulmonary metastases who underwent surgery at our centre from January 2003 to December 2007. Results: Surgery was performed in 85 patients, 56 males (66%) and 29 women (34%) with a mean age of 55.14 years (range 22-82 years). The PMCRC (Pulmonary Metastases from Colorectal Cancer) correspond to 30 patients, meaning a 35% of all resected metastases. Next in frequency were the lung metastases of osteosarcoma, 16 (19%). And really close, metastases of soft tissue sarcoma, 11 (13%). The average overall survival from PM (Pulmonary Metastases) of colorectal origin was 36.64 months (range 18.58 to 54.70 months). If we break down the overall survival at one and three years, we get a probability of survival of 96% compared to 62%. Conclusions: Although surgery cannot change the biological essence of the metastatic process, complete resection of pulmonary metastases in appropriated selected patients, can provide a significant increase in survival or even a complete and permanent remission of the tumor.

Predictive Factors for Pulmonary Metastases After Curative Resection of Rectal Cancer Without Preoperative Chemoradiotherapy

The aim of this study was to clarify the actuarial incidence of pulmonary metastases and risk factors for pulmonary metastases after curative resection of rectal cancer without preoperative chemoradiotherapy. This study was a retrospective review. Data for 314 patients who underwent R0 resection for rectal cancer without preoperative chemoradiotherapy from 2000 to 2006 were reviewed. The mean duration of follow-up was 57.0 months. Pulmonary metastases developed in 41 patients. Mean duration from rectal surgery to identification of pulmonary metastases was 21.1 months. Surgery for pulmonary metastases was performed first for 19 patients (46.3%), and all patients achieved R0 surgery. Multivariate analysis revealed that tumor depth (T3 to T4), lymph node ratio (>0.091), and tumor location (anal canal) were significant independent risk factors for pulmonary metastases. Five-year actuarial incidence of pulmonary metastasis increased significantly with increased numbers of risk factors (0 factors, 1.1%; 1 factor, 13.2%; ≥2 factors, 40.1%). In terms of lateral pelvic lymph node involvement, the number of lateral pelvic lymph node involvements (≥4) and the distribution of lateral pelvic lymph node metastases (bilateral) were significant risk factors for pulmonary metastases. The present study clearly demonstrated predictive factors for pulmonary metastases after R0 resection of rectal cancer without preoperative chemoradiotherapy. Actuarial incidence of pulmonary metastases was significantly related to the number of risk factors present. The data from the present study should facilitate the establishment of novel algorithms for predicting pulmonary metastases after resection of rectal cancer, which may lead to the appropriate surveillance strategies after rectal surgery.

Thoracoscopic surgery for pulmonary metastases after chemotherapy using a tailor-made virtual lung

Details with regard to the standard criteria for a therapeutic metastasectomy and the use of video-assisted thoracic surgery (VATS) remain elusive. To evaluate the feasibility of VATS using a tailor-made virtual lung for patients with pulmonary metastases after chemotherapy, we reviewed the following cases. Clinical data from October 2006 to April 2010 were obtained from patients who received chemotherapy before a pulmonary metastasectomy (lobectomy or segmentectomy). VATS was the primarily selected surgical approach except for treating hilar lesions. A lobectomy was performed when the metastasis was greater than 3.0 cm in diameter or located deeply in the lobe. Tailor-made virtual lungs were created using three-dimensional multidetector computed tomography before lobectomy on a routine basis. The virtual lung consisted of three-dimensional pulmonary vessels, a tracheobronchial tree, pulmonary parenchyma, and tumors. Twelve operations, consisting of 1 segmentectomy, 10 lobectomies, and 1 wedge bronchoplasty upper lobectomy, were performed on 11 patients during the study period. VATS was completed in 10 of these 12 operations. The mean operative time for the lobectomies was 257 min, and the mean operative bleeding volume was 215 ml. Two cases experienced postoperative transient atrial fibrillation, and no mortalities associated with these operations were reported. VATS was performed safely in instances of metastasectomy after chemotherapy, and the tailor-made virtual lung assisted in lung orientation during the operation.

Surgical resection for pulmonary metastasis from hepatocellular carcinoma: Analysis of prognosis in relation to primary control

Advances in local treatments for hepatocellular carcinoma (HCC) have seen better prognosis. There were few studies on surgery for pulmonary metastasis from HCC controlled by local treatment. This study was conducted to analyze prognostic factors after surgery for pulmonary metastasis from HCC. We reviewed 32 patients who underwent surgery for pulmonary metastasis from HCC and analyzed prognostic factors. HCC was controlled by surgery in 16 patients and by local treatment in 16 patients at the time of pulmonary resection. The median survival time after pulmonary resection was significantly better for HCC controlled by surgery, disease-free time >or=12 months, TMN stage I-II, and T factor 1-2 of primary HCC. The median survival time was better for lesion <or=2 and Child-Pugh score A, but they were not significant (P = 0.053, 0.069). In multivariate analysis, HCC controlled by surgical treatment (P = 0.008), and lesion <or=2 (P = 0.030) were independent prognostic factors. Our Results indicated that surgical resection for pulmonary metastasis from HCC might be beneficial for patients whose HCC was controlled by surgery and the number of lesions was lower than 3.

PD6-2-1: Surgery of pulmonary metastases as a part of multimodality concept

PD6-2-1: Surgery of pulmonary metastases as a part of multimodality concept

CLC022 ORAL Surgery of pulmonary metastases: a multimodality concept

CLC022 ORAL Surgery of pulmonary metastases: a multimodality concept