Surgical Treatment Of Pulmonary Metastases Research Articles

Long-term results in patients with lung resections for colorectal cancer metastases. Experience of a single center in Argentina

Between 5-10% of patients who undergo curative surgery for colorectal cancer (CRC) will present recurrence of their disease on the lungs. Surgical treatment of pulmonary metastases (PM) has gained popularity over the years, different publications report an overall survival rate at 5 years of between 30% and 60%. We present a review of patients with PM resections of CRC treated in a single center in Argentina. A descriptive, observational, retrospective study was conducted between 2008 and 2018. All patients with pulmonary metastasectomy of colorectal cancer were included. The primary endpoint was to evaluate overall survival and disease-free survival. Possible prognostic factors were evaluated as a secondary endpoint. A total of 99 surgeries were performed in the 68 patients, the resection was multiple in 48.5%, with more than 3 nodules in 13%. Overall and progression-free survival at 5 years was 55% and 27%, respectively. In the statistical analysis we found that the lesions in more than one lobe (p = 0.015) and the resection of more than 3 nodules (p = 0.011) presented a lower overall survival. In this retrospective analysis we evidenced comparable values to the world literature regarding morbidity, mortality, overall survival and progression-free. In our series, patients with disease in more than one lobe or more than three resected lesions had significantly lower overall survival.

Result of surgical treatment for pulmonary metastasis from hepatocellularcarcinoma

Objective: Evaluating result of surgical treatment, prognosis factors to survival time in pulmonary metastasis (PM) from Hepatocellular carcinoma (HCC) patients at Cho Ray hospital.Method: A retrospective review of surgical treatment of PM from HCC patients at Cho Ray hospital from 11/2015 – 5/2020.Results: Total 24 PM from HCC patients were surgical treatment. The mean tumor size is 2.7  1.1cm (range 1- 6 cm). The mean FDI (free disease interval) is 23.37  21.23 (2 – 108) month. Most of patients were thoracoscopic wedge resection of pulmonary metastasis. There was no mortality and major complication, 2 patients with seroma. Folow up, 7 patients died. The mean survival time 25.7  4.7 tháng (1- 46 tháng). The rate of 1 year, 2 years, 3 years overall survival is 86.5 %, 46.2% and 30.8 respectively.Conclusion: Surgical resection is a safe and effective treatment in selected patients with pulmonary metastases from HCC.The patients with previous resection of HCC have survival time longer than those with transdermal ablation. The patients with serumAFP level > 100 ng after HCC resection need to be screening chest CT Scans for PM

Outcomes and Prognostic Factors Following Surgical Treatment of Pulmonary Metastases from Colorectal Carcinoma

The lungs are the second most common site of cancer dissemination. The aim of this study was to analyze a cohort of patients operated for pulmonary metastases from colorectal carcinoma over a period of 18 years. In a group of 104 patients, relations were sought between overall survival or disease-free survival and preoperative levels of selected biomarkers, number of metastases and the condition of the intrathoracic lymphatic nodes. Median observation period was 63 months. The 5-year survival rate was 54.3%. Risk of disease progression and risk of death increases in case of occurrence of 2 or more metastases, affection of intrathoracic lymph nodes and levels of CA 19-9, TPS or CEA above cut-off value. Prognostic factors that determine overall survival as well as disease-free survival are the number of metastases, the condition of intrathoracic lymphatic nodes and the preoperative levels of biomarkers.

Changes in the surgical treatment of pulmonary metastases during the last 12 years

In our retrospective study, we examined changes in the histological results and types of metastatectomies of pulmonary metastases during the last 12 years, in two 5-year periods. There were 55 patients in the first group (2006-2010), 54.5% of the patients were male (n = 30), 45.5% were female (n = 25), the mean age was 57.9 years (24-80). The second group (2014-2018) consisted of 115 patients, with 60% male (n = 69) and 40% female (n = 46), the mean age was 62.2 years (26-82). During the first period, the primary tumor was found in the rectum 19.3% (n = 11), colon 17.5% (n = 10), or kidney 14% (n = 8), while during the second period, the primary tumor was in the colon in 23.1% (n = 31), in the rectum in 15.7% (n = 21), or in the kidney in 9% (n = 12). The following types of surgeries were performed: atypical resection: 38.6% (n = 22) and 46.3% (n = 62); lobectomy in 31.6% (n = 18) and 26.9% (n = 36); pulmonectomy in 10.5% (n = 6) and 1.5% (n = 2); segmentectomy in 7% (n = 4) and 9.7% (n = 13); and bilobectomy in 1.8% (n = 1) and 0.7% (n = 1) in the first and second group, respectively. The ratio of video-assisted thoracic surgery (VATS) was 5.3% (n = 3) during the first period, and this ratio increased to 64.9% (n = 87) during the second period. The mean disease-free survival between the surgery of the primary tumor and the removal of the pulmonary metastasis was 45.2 months (0-144) during the first period and 33.8 months (0-180) during the second period. The median survival was 39 months in the first period, and it increased to 59 months in the second group. The mean 5-year survival was 41% in both groups. During the last 12 years, there was a more than two-fold increase in the number of patients requiring surgery due to pulmonary metastases, and the ratio of VATS metastasectomy increased significantly as well (5.3% vs. 64.9%). No significant difference was found in the ratio of the types of the primary tumors. The median survival was slightly better in the second group. Orv Hetil; 161(29): 1215-1220.

Surgical treatment of pulmonary metastases in the Netherlands: data from the Dutch Lung Cancer Audit for Surgery

Surgical resection is widely employed as a potential curative treatment option for patients with limited lung metastases originating from a wide range of primary tumours. However, there are no clear national or international practice guidelines and, thereby, the risk for potential practice variation exists. This study aims to define the current practice for the surgical treatment of pulmonary metastases in the Netherlands by using data from the Dutch Lung Cancer Audit for Surgery (DLCA-S). Data from the DLCA-S were used to analyse patients undergoing a parenchymal lung resection for the treatment of pulmonary metastases between 2012 and 2017. Volume of metastasectomies per hospital was calculated as a proportion of the volume of primary lung cancer resection. Studied outcomes were overall complications and postoperative mortality and complicated course. For the latter, both the national average and between-hospital variation were calculated. A total of 2090 patients, distributed over 45 Dutch hospitals, were included for analysis. The most common primary cancer was colorectal carcinoma (N = 1087, 52.0%) followed by the urogenital carcinoma (N = 296, 14.2%). The most common type of parenchymal resection was a wedge resection (N = 1477, 70.7%) followed by a lobectomy (N = 424, 20.3%). Resection was performed minimally invasively in 1548 patients (74.1%) with a conversion rate of 3.8%. Resection of a solitary metastasis was performed in 1663 patients (79.6%). In 40 patients (1.9%), 4 or more metastases were resected. A postoperative complicated course was noted in 3.6%, and the 30-day mortality rate was 0.7%. The variety between hospitals in the volume of metastasectomies in proportion to the volume of primary lung cancer resections was 3.4-41.5%. This analysis of the DLCA-S registry provides a unique insight into current practice on pulmonary metastasectomies in the Netherlands over a 6-year period. The rate of postoperative adverse outcome was limited, and the morbidity and mortality were lower compared to primary lung cancer resections in the DLCA-S database.

Optimal timing for the resection of pulmonary metastases in patients with colorectal cancer.

This study aims to clarify the surgical treatment time of pulmonary metastasis in patients with colorectal cancer.Early relapse after resection of pulmonary metastasis is often encountered when the interval from the detection of pulmonary metastasis to pulmonary metastasectomy was short.In this retrospective analysis, data of patients with colorectal cancer who underwent surgical treatment of pulmonary metastasis at the Gunma Prefectural Cancer Center, Gunma, from April 2001 through September 2018 were evaluated. The patients were divided into 2 groups. We examined the interval period from the diagnosis of pulmonary metastasis to pulmonary metastasectomy. This period was divided into every 3 months, and the prognosis of each group was compared with clarify the appropriate timing of pulmonary metastasectomy.The primary endpoints were 5-year overall survival and recurrence-free survival rates.The most significant difference was observed when the cutoff value was 9 months (5-year recurrence-free survival 45.8% vs 85.6%, P < .01). No significant difference was found in any background factors between the 2 groups. Twenty-five patients (34.7%) experienced recurrence after pulmonary metastasectomy. The most common site of recurrence was the lung (48%). Among the 12 cases of recurrence of pulmonary metastasis, 11 cases belonged to the <9 months group. A multivariable survival analysis found that the interval period of <9 months was a significant predictor of recurrence.Our study suggests that clinical follow-up for 9 months prior pulmonary metastasectomy in colorectal patients would improve the prognosis.

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。

Advancement in the surgical treatment of pulmonary metastasis

The management of pulmonary metastases is a target in constant movement. Historically, it has been assumed that patients have a very poor survival when a primary tumour invades other organs, particularly the lungs. Some preliminary works have demonstrated that a substantial number of patients undergoing lung metastasectomy enjoy complete remission, thus benefit of prolonged survival. Initially proposed for highly selected patients with specific cancers, the indication of metastasectomy has expanded to various primary solid tumors and is now proposed in daily practice for a large number of patients, accounting for almost 10% of our surgical activity.

Surgical treatment of pulmonary metastasis in colorectal cancer patients: Current practice and results.

Colorectal cancer (CRC) is a frequently occurring disease, yet diagnosed at a local stage in only 40% of cases. Lung metastases (LM) appear in 5-15% of patients and, left untreated, carry a very poor prognosis. Some CRC patients may benefit from a potentially curative LM resection, but success and benefit are difficult to predict. We discuss prognostic factors of survival after lung metastasectomy in CRC patients under several scenarios (with/ without prior liver metastases; repetitive pulmonary resections). We reviewed all studies (2005-2015) about pulmonary metastases surgical management with curative intent in CRC patients, with a minimum threshold on the number of patients reported (without prior liver metastases: n ≥ 100; with prior resection of liver metastases: n ≥ 50; repetitive thoracic surgery: n ≥ 30). The picture of the prognostic factors of survival is nuanced: surgical management demonstrates clear successes and steady progress, yet there is no single success criterion; stratification of patients and selection bias impact the conclusions. Surgical management of liver and lung metastases may prolong life or cure CRC patients, provided the lesions are fully resected and patients carefully selected. Repeat lung metastasectomy is a safe approach to treat patients in selected cases. In conclusion, there is no standard for surgical management in CRC patients with pulmonary metastases. Patients with isolated unilateral lung metastasis with normal CEA level and no lymph node involvement benefit the most from surgery. Most series report good results in highly selected patients, but instances of long-term disease-free survival remain exceptional.

Surgical Treatment for Pulmonary Metastases of Osteosar-Coma

Abstract Introduction. Osteosarcomas represent 40% of bone sarcomas and occur mainly in children and young adults. They are tumors with a high degree of pulmonary metastasis. Pulmonary metastases occur in about 80% of the relapsed patients after primary tumor therapy, whether or not they have received chemotherapy. As therapeutic solutions, both first intention resection of the metastasis and the post-chemotherapy resection or repeated resections in each relapse, represent satisfactory results with prolongation of survival. Material and method. The present study describes a group of 17 patients who were surgically treated for osteosarcoma with different localizations and who presented themselves in the thoracic surgery department during 2011-2016 with suspicion of pulmonary metastases. Three of them were at their second intervention for metastasis resection. Following investigations, 4 of them (23.5%) could not benefit from surgical resection of pulmonary metastases (lesional extension with postoperative vital risk or technical impossibility of metastatic excision). Surgical interventions were curative; lobectomies were performed in 4 cases (30.7%), atypical resections in 8 cases (61.6%) and one pneumonectomy (7.7%). Postoperative progression was favorable in all 13 patients. Discussions and conclusions. Surgical excision of osteosarcoma pulmonary metastases can prolong survival and sometimes even cure disease. In order to benefit from the intervention, the patient should be served by a thoracic surgery clinic in the shortest possible time after the discovery of the pulmonary nodules. Thus, the need for thoracic imaging is required in patients treated for osteosarcoma. Late presentation makes the intervention impossible, particularly because of the lesional extension in the lung parenchyma or the invasion of the adjacent structures, extension given by the number of metastases or their size.

PROGNOSTIC FACTORS IN THE TREATMENT OF LUNG METASTASES FROM COLORECTAL CANCER

Based on the results of worldwide clinical studies, survival of colorectal cancer patients with lung metastases is significantly influenced by curative resection, number of metastases and disease free interval. Intrathoracic lymph node metastases in combination with pulmonary metastases as well as the CEA level of greater than 10ng/ml are found to be the most unfavorable prognostic factors. Most studies have found no significant relationship between survival and the size of the primary tumor and unilateral/bilateral distribution of pulmonary metastases. However, some authors consider that bilateral metastasis and T3-4 tumors are unfavorable prognostic factors. The key factors for surgical treatment of pulmonary metastases are the feasibility of performing curative resection and the absence of other manifestations of the disease.

Surgical treatment of pulmonary metastasis: report from a tertiary care center.

Objective This retrospective analysis aimed to determine the factors influencing prognosis in adult patients who presented to our thoracic surgery service with lung metastases and were eligible for pulmonary metastasectomy. Methods We retrospectively reviewed the data of 296 patients who underwent resection of 575 lung metastases from January 2000 to January 2016. Univariate and multivariate analyses were performed based on age, sex, histology of the primary tumor, disease-free interval, number and size of metastases. Results Sixty-eight (22.97%) patients developed lung metastases from bone sarcoma, 68 (22.97%) from soft-tissue sarcoma, 56 (18.9%) from head and neck cancers, 46 (15.5%) from colorectal cancer, and 58 (19.6%) from other epithelial tumors. The mean size of the lung nodules was 2.48 cm. Open surgical resection was performed in 217 (73.3%) patients. After a mean follow-up of 43 months, 120 (40.7%) patients had died or were lost to follow-up. Univariate analysis confirmed that patients with bone cancer, soft tissue sarcoma, or colorectal carcinoma had a worse prognosis ( p = 0.0003). Moreover, those with a disease-free interval >24 months had a better 5-year survival ( p = 0.0001). The number and size of metastases, age, and sex had no effect on prognosis. The actuarial survival after complete metastasectomy was 71.6% (95% confidence interval: 66-75) at 2 years and 59.3% (95% confidence interval: 56-64) at 5 years. Conclusions Pulmonary metastasectomy provides good long-term survival. The type of primary tumor and disease-free interval are independent prognostic factors for survival.

Surgical treatment of pulmonary metastases in pediatric solid tumors

Most children who succumb to solid malignancies do so because of the burden of metastatic disease or due to complications associated with the therapy administered to treat metastatic disease. Approximately one-quarter of children with solid tumors will present with metastatic disease, and an additional 20% ultimately develop metastatic disease, most commonly in the lung. The role of surgery in the treatment of metastatic solid tumors, given its disseminated nature, is not intuitive, yet there are circumstances in which surgical resection of metastatic disease can potentially be curative. However, the utility of surgery is very much dependent on histology, and generally is most appropriate for those malignancies with histologies that are refractory to other adjuvant therapies.

477. Surgical treatment of pulmonary metastases: Analysis of 80 our patients

477. Surgical treatment of pulmonary metastases: Analysis of 80 our patients

Lung surgery for metastatic epithelial tumours.

The aim of this study is to evaluate outcomes following the surgical treatment of pulmonary metastases in patients with different types of epithelial cancers, as well as to identify prognostic factors after metastasectomy. We retrospectively reviewed data for 61 patients who underwent 76 curative resections of pulmonary metastases from epithelial tumours during 1997-2002 at our department. Potential prognostic factors affecting survival after lung metastasectomy were analysed: disease-free interval (DFI), gender, age, the size and number of metastases, mono- or bilateral tumour, number of operations and the extent of pulmonary resection. The median survival was 36 months. Three factors were identified as prognostic for survival after metastasectomy: DFI<24 (p=0.0045), unilateral pulmonary metastases (p=0.0062) and no more than one operation (p=0.0065). We concluded that: i) Resection of epithelial pulmonary metastases may offer a significant survival benefit for selected patients. ii) Good surgical candidates for pulmonary resection are those with a disease-free interval greater than 24 months. iii) The total number of thoracotomies, and metastases confined to one lung are factors defining patients who experience a better outcome after surgery. iv) Lung metastasectomy by conventional surgery is a safe procedure with low perioperative morbidity and mortality rates.

Evaluation of prognostic factors in the surgical treatment of pulmonary metastases.

Aim of the studyThe resection of pulmonary metastases is a routine practice of thoracic surgery wards; however, clear protocols or prognostic factors defining the surgical treatment criteria are still not available. The aim of the study is to evaluate the prognostic factors associated with long-term survival in a group of patients who underwent resection of pulmonary metastases.Material and methodsA retrospective analysis was conducted on a group of 250 patients admitted to the Wrocław Thoracic Surgery Centre for radical resection of pulmonary lesions in the years 1996–2010.ResultsThe patients included in the study (n = 250) underwent 339 thoracotomies in total. The overall five-year survival was 52.8%. The univariate data analysis showed that the survival rate was significantly better in patients subjected to more than one thoracotomy (p = 0.01674). Among the other data, such as sex, tumour histology, disease-free interval (DFI) ≤ 12 and > 12 months, DFI ≤ 36 and > 36 months, age, number of tumours identified in CT and number of tumours subject to resection, operated side, resection type, radicality of resection, extent of lymphadenectomy, and adjuvant therapy, no statistical significance was observed in univariate and multivariate analysis (p > 0.05).ConclusionsOutcomes of re-metastasectomy are satisfactory if patients meet the baseline criteria for surgical treatment. None of the evaluated factors potentially influencing the patient survival was demonstrated to have any prognostic value. Further research, including the biology of tumours with pulmonary metastases, is necessary to select the group of patients that will benefit most from surgical treatment.

Pulmonary metastasectomy for colorectal cancer: how many nodules, how many times?

Colorectal cancer (CRC) is one of the most common cancers worldwide, with 5%-15% of CRC patients eventually developing lung metastasis (LM). Despite doubts about the role of locoregional therapy in the management of systemic disease, many surgeons have performed pulmonary metastasectomy (PM) for CRC in properly selected patients. However, the use of pulmonary metastasectomy remains controversial due to the lack of randomized controlled studies. This article reviews the results of surgical treatment of pulmonary metastases for CRC, focusing on (1) current treatment guidelines and surgical techniques of PM in patients with LM from CRC; (2) outcomes of PM and its prognostic factors; and (3) controversial issues in PM, focusing on repeated metastasectomy, bilateral multiple metastases, and combined liver and lung metastasectomy.

Results of a surgical resection of pulmonary metastasis from hepatocellular carcinoma: prognostic impact of the preoperative serum alpha-fetoprotein level

Pulmonary metastasis is the most common type of extrahepatic recurrence of hepatocellular carcinoma (HCC). The outcome of pulmonary metastasectomy of HCC has not yet been thoroughly investigated. The outcomes of surgical treatment of pulmonary metastases from HCC were reviewed in order to analyze the postoperative survival and the relevant prognostic factors. This study retrospectively reviewed 20 patients who underwent pulmonary metastasectomy from an HCC between 1990 and 2007 at two institutions. The surgical outcome was evaluated by both the overall survival and cancer-specific survival after pulmonary resection. The association between various clinico-pathological factors and the survival outcome was analyzed. The overall survival rate after the initial pulmonary metastasectomy was 46.9% at 5years, and the cancer-specific 5-year survival rate was 63.2%. One patient died of surgery-related events 19days after the pulmonary resection. The preoperative AFP (alpha-fetoprotein) level was found to be a significant prognostic factor for both overall and cancer-specific survival for patients undergoing pulmonary metastasectomy. Both the overall and cancer-specific survival rates were significantly worse for the patients with AFP≥500ng/ml in comparison to those with AFP<500ng/ml (p<0.05). No other factors were associated with the survival after pulmonary metastasectomy. The serum level of AFP might be a valuable predictor for the outcome of pulmonary metastasectomy required for metastasis of HCC.

Surgical Approach to Pulmonary Metastases from Breast Cancer

One of the main characteristics of breast cancer is its capability to disseminate. Solitary pulmonary metastases from breast cancer occur rarely (0.4%). The aim of this study is to check whether or not the outcome following the surgical treatment of pulmonary metastases in patients with breast cancer is in accordance with the data in the literature and based on it to identify prognostic factors. We have reviewed retrospectively data for 33 patients who underwent 43 curative resections of breast cancer pulmonary metastases between 1997 and 2002 at our department. Potential prognostic factors affecting survival, namely survival after lung metastasectomy, assessed were disease-free interval (DFI), the number and location of lung metastases, the diameter in mm of metastases and the extent of pulmonary resection. The median survival for 33 patients with pulmonary breast cancer metastatic lesions after metastasectomy was 73.2 months. Mean 5-year survival was 54.5%. There was a statistically significant difference in survival time with better prognosis for patients with DFI > 36 months (p = 0.0007), complete metastasectomy (p = 0.0153), unilateral pulmonary metastases (p=0.0267) and for patients who underwent multiple operations (p = 0.0211). In multivariate analysis there was significant influence for long-term prognosis for patients with DFI > 36 months (p = 0.0446) and for complete resection of the metastases (p = 0.0275). Analysis of the survival rates for patients with solitary pulmonary metastasis, with different size of tumors and after different types of pulmonary resection showed no significant differences. It was concluded that resection of lung metastases from breast cancer may offer a significant survival benefit for selected patients. The identified prognostic factor for survival after metastasectomy is DFI longer than 36 months and complete resection of the metastases. In our group of patients, DFI longer than 36 months, unilateral pulmonary metastases and number of operations significantly influenced survival. Also, the results showed that lung metastasectomy by conventional surgery is a safe procedure with low perioperative morbidity and mortality rate.

Supplement 2, Proceedings of the 14th World Conference on Lung Cancer, Book 2

Supplement 2, Proceedings of the 14th World Conference on Lung Cancer, Book 2