Is repeated pulmonary metastasectomy justified?
- PDF / 685,127 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 37 Downloads / 203 Views
RESEARCH PAPER
Is repeated pulmonary metastasectomy justified? Céline Forster1 · Amaya Ojanguren1 · Jean Yannis Perentes1,2 · Matthieu Zellweger1 · Sara Federici1 · Thorsten Krueger1,2 · Etienne Abdelnour‑Berchtold1 · Michel Gonzalez1,2 Received: 8 June 2020 / Accepted: 6 September 2020 © The Author(s) 2020
Abstract Recurrence after pulmonary metastasectomy (PM) is frequent, but it is unclear to whom repeated pulmonary metastasectomy (RPM) offers highest benefits. Retrospective analysis of oncological and post-operative outcomes of consecutive patients who underwent PM from 2003 to 2018. Overall survival (OS) and disease-free interval (DFI) were calculated. Cox regression was used to identify variables influencing OS and DFI. In total, 264 patients (female/male: 114/150; median age: 62 years) underwent PM for colorectal cancer (32%), sarcoma (19%), melanoma (16%) and other primary tumors (33%). Pulmonary metastasectomy was approached by video-assisted thoracic surgery (VATS) in 73% and pulmonary resection was realized by non-anatomical resection in 76% of cases. The overall median follow-up time was 33 months (IQR 16–56 months) and overall 5-year survival rate was 62%. Local or distant recurrences were observed in 172 patients (65%) and RPM could be performed in 66 patients (25%) for a total of 116 procedures. RPM was realized by VATS in 49% and pulmonary resection by wedge in 77% of cases. In RPM patients, the 5-year survival rate after first PM was 79%. Post-operative cardio-pulmonary complication rate (13% vs. 12%; p = 0.8) and median length of stay (4 vs. 5 days; p = 0.2) were not statistically different between first PM and RPM. Colorectal cancer (HR 0.56), metachronous metastasis (HR 0.48) and RPM (HR 0.5) were associated with better survival. In conclusion, our results suggest that RPM offers favorable survival rates without increasing post-operative morbidity. Keywords Pulmonary metastases · Pulmonary metastasectomy · VATS · Repeat metastasectomy
Introduction Pulmonary metastases are frequently encountered in patients with solid primary tumors [1–4]. Pulmonary metastasectomy (PM) has become an accepted part of a multidisciplinary treatment [5], if (i) the primary tumor is controlled, (ii) there is no other extra-thoracic metastasis and (iii) the patients can tolerate the surgery [6]. In addition, in light of recent improvements in surgical and radiological technologies, such as the Video-Assisted Thoracic Surgery (VATS) approach and the 1-mm thin slice CT scan, PM has become technically easier and morbidity and mortality rates have decreased [7, 8]. * Michel Gonzalez [email protected] 1
Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011 Lausanne, Switzerland
2
However, recurrences after PM occur in more than 50% of patients, making some of them potential candidates for a repeated PM (RPM) [1, 9, 10]. The indications for RPM are controversial, particularly since systemic
Data Loading...
