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Huang W, Deng HY, Liu Z, Wang YF, Xu K, Lin MY, Wang YQ, Zhou Q. Lymph node dissection in small-sized pulmonary metastasectomy: Impact on the long-term survival. Asian J Surg 2024; 47:3899-3904. [PMID: 38609822 DOI: 10.1016/j.asjsur.2024.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/03/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Pulmonary metastasectomy has been clarified in improving long-term survival in most primary malignancies with pulmonary metastasis, while the role of additional lymph node dissection remained controversial. We aimed to investigate the prognosis of lymph node involvement and identify the role of lymph node dissection during pulmonary metastasectomy in a real-world cohort. METHODS We identified patients diagnosed with pulmonary metastases with ≤3 cm in size and received pulmonary metastasectomy between 2004 and 2017 in the Surveillance, Epidemiology, and End Results database. We compared the survival via Kaplan-Meier analysis and propensity score matching method, and the multivariable analysis was conducted by cox regression analysis. RESULTS A total of 3452 patients were included, of which 2268(65.7%) received lymph node dissection, and the incidence of node-positive was 11.3%(256/2268). In total, the median overall survival was 62.8 months(interquartile range, 28.6-118.9 months), and the lymph node involvement was referred to an impaired survival compared to node-negative diseases(5-year overall survival rate, 58.0% versus 38.6%), with comparable survival between N1 and N2 diseases(P = 0.774). Lymph node dissection was associated with improved survival(HR = 0.80; 95%CI, 0.71-0.90; P < 0.001), and the survival benefits remained regardless of age, sex, the number of metastases, and surgical procedures, even in those with node-negative diseases. At least eight LNDs might lead to a significant improvement in survival, and additional survival benefits might be limited with additional dissected lymph nodes. CONCLUSIONS Lymph node involvement was associated with impaired survival, and lymph node dissection during pulmonary metastasectomy could improve long-term survival and more accurate staging.
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Affiliation(s)
- Weijia Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China; Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Han-Yu Deng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China; Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
| | - Zhenkun Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China; Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Yi-Feng Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China; Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Kai Xu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China; Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Ming-Ying Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Yu-Qi Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Qinghua Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China; Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
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Rodríguez-Fuster A, Díaz-Ravetllat V. Multicentre retrospective analysis on pulmonary metastasectomy: a European perspective. Eur J Cardiothorac Surg 2024; 65:ezae224. [PMID: 38833677 DOI: 10.1093/ejcts/ezae224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/02/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Albert Rodríguez-Fuster
- Thoracic Surgery Department, Hospital del Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
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Scanagatta P, Ancona G, Cagnetti S, Giorgetta CE, Inzirillo F, Ravalli E, Maiolani M, Naldi G. The Case for Pulmonary Metastasectomy-Clinical Practice Narrative Review and Commentary. Life (Basel) 2024; 14:702. [PMID: 38929685 PMCID: PMC11204682 DOI: 10.3390/life14060702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Pulmonary metastasectomy has become a well-established procedure for patients with certain types of solid tumors. Patients are usually scheduled for staged lung metastasectomy in case of primary tumor control, the absence of distant non-lung metastases, and when complete resection is achievable. Nodules are removed with precision resection in order to ensure radical resection with minimal margins; this technique permits good oncological results, preserving the surrounding pulmonary parenchyma and causing minimal distortion compared to staplers. When possible, anatomical resections should be avoided since they are not justified by real oncological advantages and, in the majority of cases, sacrifice too much healthy tissue, possibly leading to inoperability in the case of metachronous relapses. Thus, preserving the maximum amount of pulmonary parenchyma is crucial because repeated metastasectomies are possible and frequent, with no theoretical limits to the number of reinterventions. In our multidisciplinary board team, we support the role of pulmonary metastasectomy as a useful curative therapy, with acceptable morbidity and mortality, with indications to be discussed case-by-case.
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Affiliation(s)
- Paolo Scanagatta
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Gianluca Ancona
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Sara Cagnetti
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Casimiro Eugenio Giorgetta
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Francesco Inzirillo
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Eugenio Ravalli
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Martina Maiolani
- Division of Oncology, ASST Valtellina e Alto Lario, “Ospedale Civile” Sondrio, 23100 Sondalo, Italy
| | - Giuseppe Naldi
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
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4
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Hassan M, Ehle B, Le UT, Titze L, Passlick B, Grapatsas K. Outcome of Repeated Resection of Pulmonary Metastases for Renal Cell Cancer. Thorac Cardiovasc Surg 2023; 71:130-137. [PMID: 35987192 DOI: 10.1055/s-0042-1755555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND To date, many studies investigated results and prognostic factors of pulmonary metastasectomy (PM) in renal cell cancer (RCC). However, reports concerning repeated resection for patients with recurrent pulmonary metastases (RPM) are limited. In this study, we analyzed safety, efficacy, and prognostic factors for survival after PM focusing on RPM for RCC. PATIENTS AND METHODS Clinical, operative, and follow-up data of patients who underwent PM or RPM for RCC in our institution were retrospectively collected and correlated with each other from January 2005 to December 2019. RESULTS Altogether 154 oncological pulmonary resections in curative intention as PM or RPM were performed in 82 and 26 patients. Postoperative complications were similar in both groups (n = 22 [26.8%] vs. 4 [15.4%], p = 0.2). Zero mortality was documented up to the 30th postoperative day. RPM was not associated with decreased 5-year-survival compared with PM (66.2 vs. 57,9%, p = 0.5). Patients who underwent RPM for recurrent lung metastases had a better overall survival in comparison with the other treatments including chemotherapy, radiotherapy, immunotherapy, and best supportive care (p = 0.04). In the multivariate analysis, disease-free survival was identified as an independent prognostic factor for survival (hazard ratio: 0.969, 0.941-0.999, p = 0.04). CONCLUSION RPM is a safe and feasible procedure. The resection of recurrent lung metastases shows to prolong survival in comparison with the other therapeutic options for selected patients with RCC.
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Affiliation(s)
- Mohamed Hassan
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benjamin Ehle
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Uyen-Thao Le
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laurin Titze
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Mikhail M, Chua KJ, Khizir L, Tabakin A, Singer EA. Role of metastasectomy in the management of renal cell carcinoma. Front Surg 2022; 9:943604. [PMID: 35965871 PMCID: PMC9372304 DOI: 10.3389/fsurg.2022.943604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Treatment of metastatic renal cell carcinoma (mRCC) has evolved with the development of a variety of systemic agents; however, these therapies alone rarely lead to a complete response. Complete consolidative surgery with surgical metastasectomy has been associated with improved survival outcomes in well-selected patients in previous reports. No randomized control trial exists to determine the effectiveness of metastasectomy. Therefore, reviewing observational studies is important to best determine which patients are most appropriate for metastasectomy for mRCC and if such treatment continues to be effective with the development of new systemic therapies such as immunotherapy. In this narrative review, we discuss the indications for metastasectomies, outcomes, factors associated with improved survival, and special considerations such as location of metastasis, number of metastases, synchronous metastases, and use of systemic therapy. Additionally, alternative treatment options and trials involving metastasectomy will be reviewed.
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Affiliation(s)
| | | | | | | | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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6
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The prognostic effect of lymph node dissection in secondary lung tumor metastasectomies. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:235-240. [PMID: 36168561 PMCID: PMC9473603 DOI: 10.5606/tgkdc.dergisi.2022.21402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/09/2021] [Indexed: 11/21/2022]
Abstract
Background: In this study, we aimed to investigate the prognostic effect of lymph node dissection in secondary lung tumor metastasectomies.
Methods: Between January 2001 and December 2015, a total of 201 patients (122 males, 79 females; mean age: of 41.4±19.2 years; range, 3 to 79 years) who had pulmonary metastasectomy due to colorectal carcinoma, renal cell carcinoma, and soft tissue - skeletal sarcomas were retrospectively analyzed. The clinicopathological features of the patients, overall survival, and complication rates according to the presence of lymph node dissection were evaluated.
Results: The most common histopathological subtype was a sarcoma in 118 (58.7%) patients, followed by colorectal carcinoma in 63 (31.3%) patients, and renal cell carcinoma in 20 (10%) patients. A total of 88 (43.7%) patients underwent systematic lymph node dissection with pulmonary metastasectomy. The mean overall survival of patients with and without lymph node dissection were 49±5.9 (95% confidence interval 37.3-60.6) and 26±4.4 (95% confidence interval 17.2-34.7) months, respectively (p=0.003). The five-year survival rates in colorectal carcinoma, renal cell carcinoma, and sarcoma were 52%, 30%, and 23%, respectively (p=0.002). Locoregional recurrences occurred in 15 (35.7%) patients in the lymph node dissection group and in 23 (60.5%) patients in the non-lymph node dissection group (p=0.026). Lymph node dissection did not show a significant relationship regarding to postoperative complications (p=0.09).
Conclusion: Lymph node dissection following pulmonary metastasectomy may improve the overall survival and reduce locoregional recurrence, without any increase in morbidity and mortality.
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7
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Sellner F, Thalhammer S, Klimpfinger M. Isolated Pancreatic Metastases of Renal Cell Cancer: Genetics and Epigenetics of an Unusual Tumour Entity. Cancers (Basel) 2022; 14:1539. [PMID: 35326690 PMCID: PMC8945920 DOI: 10.3390/cancers14061539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022] Open
Abstract
Isolated pancreatic metastases of renal cell carcinoma (isPMRCC) are a rare manifestation of metastatic renal cell carcinoma (mRCC) characterized by two peculiarities: (1). The definite or at least long-term exclusive occurrence of metastases in the pancreas and (2). an unusual low tumour aggressiveness with slow tumour progression and consecutive, good treatment results. According to current knowledge, the exclusive occurrence of pancreatic metastases is due to a highly specific and highly selective seed and soil mechanism, which does not allow metastases settlement outside the pancreas, and whose detailed genetic/epigenetic causes are not yet elucidated. Recent studies have shed light on some of the pathways involved for the protracted course of the disease and highlighted a special genetic profile (lack of loss of 9p, lower weight genome instability index, low frequency of BAP1 alterations, and a high frequency of PBRM1 loss), which deviates from the conventional mRCC profile. Finally, the question of the reasons for the long-term relative genetic stability of the involved cell clones, which is an essential prerequisite for a favourable prognosis, remains unanswered.
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Affiliation(s)
- Franz Sellner
- Department of General-, Visceral- and Vascular Surgery, Clinic Favoriten—Kaiser Franz Josef Hospital, 1100 Vienna, Austria;
| | - Sabine Thalhammer
- Department of General-, Visceral- and Vascular Surgery, Clinic Favoriten—Kaiser Franz Josef Hospital, 1100 Vienna, Austria;
| | - Martin Klimpfinger
- Clinical Institute of Pathology, Medical University, 1090 Vienna, Austria;
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8
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Kanzaki R, Fukui E, Kanou T, Ose N, Funaki S, Minami M, Shintani Y, Okumura M. Preoperative evaluation and indications for pulmonary metastasectomy. J Thorac Dis 2021; 13:2590-2602. [PMID: 34012607 PMCID: PMC8107542 DOI: 10.21037/jtd-19-3791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary metastasectomy (PM) is an established treatment that can provide improved long-term survival for patients with metastatic tumor(s) in the lung. In the current era, where treatment options other than PM such as stereotactic body radiation therapy (SBRT), immunotherapy, and molecular-targeted therapy are available, thoracic surgeons should review the approach to the preoperative evaluation and the indications. Preoperative evaluation consists of history and physical examinations, physiological tests, and radiological examinations. Radiological examinations serve to identify the differential diagnosis of the pulmonary nodules, evaluate their precise number, location, and features, and search for extra thoracic metastases. The indication of PM should be considered from both physiological and oncological points of view. The general criteria for PM are as follows; (I) the patient has a good general condition, (II) the primary malignancy is controlled, (III) there is no other extrapulmonary metastases, and (IV) the pulmonary lesion(s) are thought to be completely resectable. In addition to the general eligibility criteria of PM, prognostic factors of each tumor type should be considered when deciding the indication for PM. When patients have multiple poor prognostic factors and/or a short disease-free interval (DFI), thoracic surgeons should not hesitate to observe the patient for a certain period before deciding on the indication for PM. A multidisciplinary discussion is needed in order to decide the indication for PM.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Eriko Fukui
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Japan
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Seitlinger J, Prieto M, Siat J, Renaud S. Pulmonary metastasectomy in renal cell carcinoma: a mainstay of multidisciplinary treatment. J Thorac Dis 2021; 13:2636-2642. [PMID: 34012612 PMCID: PMC8107562 DOI: 10.21037/jtd-2019-pm-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Renal cell carcinoma (RCC) remains a public health issue and seems to be increasing. A significant proportion of RCC patients will develop pulmonary metastasis at some point in their evolution. In this review, we aimed to update the surgical management of pulmonary metastases as well as systemic therapy, including targeted therapies, according to recent data in the literature. We retrospectively reviewed studies evaluating the benefit of pulmonary metastasectomy in RCC patients and evaluating the place of different chemotherapies, targeted therapies and immunotherapies through November 1, 2019. Several retrospective studies have shown the benefit of pulmonary metastasectomy in metastatic RCC (mRCC), most in a situation with only pulmonary metastases. According to the prognostic criteria of the IMDC risk model, the patient is classified into a prognostic group to identify the best systemic treatment. With the development of targeted therapies, the modalities are multiple and may involve tyrosine kinase inhibitors/checkpoint inhibitors and soon vaccine therapy or CAR-T cells. At the local level, in patients who cannot benefit from surgery, stereotactic radiotherapy or radiofrequency has a place to be considered. Although there is a lack of a randomized study, pulmonary metastasectomy appears to be feasible and effective. The place and modalities of systemic therapies in the era of targeted therapies remain to be more clearly defined.
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Affiliation(s)
- Joseph Seitlinger
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Mathilde Prieto
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Joelle Siat
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
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Abstract
The lung is one of the most common sites of metastatic disease. Assessing patients for pulmonary metastasectomy includes ensuring they are suitable surgical candidates for single-lung ventilation and pulmonary resection. Complete resection of metastases and control of primary tumor and oligometastatic disease are key tenets for metastasectomy. Negative prognostic factors include short disease-free interval, presence of lymphadenopathy, and multiple lesions. Primary tumors are associated with excellent outcomes. With modern high-resolution scans, minimally invasive approaches to metastasectomy are preferred. Consideration of extended resections should take place in a multidisciplinary manner. Nonoperative options include stereotactic body radiation therapy, radiofrequency ablation, and microwave ablation.
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Surgery versus stereotactic radiotherapy for treatment of pulmonary metastases. A systematic review of literature. Future Sci OA 2020; 6:FSO471. [PMID: 32518686 PMCID: PMC7273364 DOI: 10.2144/fsoa-2019-0120] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
It is not clear as to which is the best treatment among surgery and stereotactic radiotherapy (SBRT) for lung oligometastases. A systematic review of literature with a priori selection criteria was conducted on articles on the treatment of pulmonary metastases with surgery or SBRT. Only original articles with a population of patients of more than 50 were selected. After final selection, 61 articles on surgical treatment and 18 on SBRT were included. No difference was encountered in short-term survival between pulmonary metastasectomy and SBRT. In the long-term surgery seems to guarantee better survival rates. Mortality and morbidity after treatment are 0–4.7% and 0–23% for surgery, and 0–2% and 4–31% for SBRT. Surgical metastasectomy remains the treatment of choice for pulmonary oligometastases. Patients with metastatic cancer with a limited number of deposits may benefit from surgical removal or irradiation of tumor nodules in addiction to chemotherapy. Surgical resection has been demonstrated to improve survival and, in some cases, can be curative. Stereotactic radiotherapy is emerging as a less invasive alternative to surgery, but settings and implications of the two treatments are profoundly different. The two techniques show similar results in the short-term, with lower complications rates for radiotherapy, while in the long-term surgery seems to guarantee higher survival rates.
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12
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Agolli L. Stereotactic body radiation therapy could improve disease control in oligometastatic patients with renal cell carcinoma: do we need more evidence? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S105. [PMID: 31576312 DOI: 10.21037/atm.2019.05.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Linda Agolli
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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13
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[Rationale of thoracic lymph node dissection in pulmonary metastasectomy]. Chirurg 2019; 90:991-996. [PMID: 31501935 DOI: 10.1007/s00104-019-01030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The goal of metastasectomy is a R0 resection. Depending of the tumor entity the prevalence of lymph node metastases in pulmonary metastasectomy can be up to 45%; however, systematic lymph node dissection is not yet established as a fixed component of metastasectomy. Although there is a high prevalence of lymph node metastases and the increase in the prevalence with a higher number of lung metastases, it remains unclear if a systematic lymph node dissection should be part of pulmonary metastasectomy. For this reason, the goal of this review was to evaluate the rationale of systematic lymph node dissection in pulmonary metastasectomy based on the currently available literature. Furthermore, it was investigated whether patients with additional thoracic lymph node metastases should be excluded per se from pulmonary metastasectomy, even though positive lymph node metastases might be associated with a lower but nevertheless good long-term survival after resection.
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14
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Sponholz S, Schirren M, Oguzhan S, Mese M, Schirren J. Long-term Outcome After Resection of Isolated Thoracic Lymph Node Metastases of Renal Cell Cancer. Ann Thorac Surg 2019; 109:262-269. [PMID: 31499030 DOI: 10.1016/j.athoracsur.2019.07.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Isolated thoracic lymph node metastases (ITLNMs) without any lung metastases of renal cell cancer are rare. Other than a few case reports and one study, there is no further literature on ITLNMs. For this reason, the goal of this study was to analyze our experiences, the long-term survival outcomes, and recurrence-free survival outcomes after the resection of ITLNMs. METHODS We analyzed our database of 15 patients with ITLNMs who underwent metastasectomy by systematic lymph node dissection from 2003 to 2017. The long-term outcomes and survival curves were analyzed with the Kaplan-Meier method. RESULTS The median disease-free interval between primary cancer and ITLNM was 40 months (range, 0-171 months). The R0 resection rate was 93.3% (n = 14). There was one R2 resection, which was due to a tracheal and left main bronchial infiltration. The postoperative morbidity and 30-day mortality rates were 13.3% and 0%, respectively. Altogether, 14 patients were included in the long-term follow-up with a median follow-up time of 35.5 months (range, 2-108 months). The 1-, 3-, and 5-year survival rates were 93%, 73%, and 73%, respectively. The median overall progression-free survival after metastasectomy was 18 months (95% confidence interval, 8.6-27.4 months), and the 5-year local recurrence-free rate was 65%. CONCLUSIONS Because of the long disease-free interval between primary cancer and ITLNM, a long oncologic follow-up that includes chest images should be mandatory. Altogether, metastasectomy of ITLNMs is feasible with low morbidity and mortality rates and might be associated with promising survival rates. Early detection and resection of ITLNMs may avoid severe complications.
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Affiliation(s)
- Stefan Sponholz
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany.
| | - Moritz Schirren
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Selma Oguzhan
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Mesut Mese
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Joachim Schirren
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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Nonselective Lymph Node Dissection and Sentinel Lymph Node Mapping and Biopsy. Vet Clin North Am Small Anim Pract 2019; 49:793-807. [PMID: 31147188 DOI: 10.1016/j.cvsm.2019.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Clinical staging is important for determining the extent of disease in animals with malignant cancers. The status of the lymph node will help determine whether adjuvant treatment is indicated. Historically, the regional anatomic lymph node has been sampled to determine the presence or absence of metastatic disease, but there is increasing evidence that the regional anatomic lymph node is often different to the sentinel lymph node. As a result, several sentinel lymph node mapping techniques have been described for more accurate clinical staging of oncologic patients.
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16
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Achkar T, Maranchie JK, Appleman LJ. Metastasectomy in Advanced Renal Cell Carcinoma: A Systematic Review. KIDNEY CANCER 2019. [DOI: 10.3233/kca-180042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tala Achkar
- Department of Medicine, University of Pittsburgh, School of Medicine, Division of Hematology/Oncology, Pittsburgh PA, USA
| | - Jodi K. Maranchie
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Leonard J. Appleman
- Department of Medicine, University of Pittsburgh, School of Medicine, Division of Hematology/Oncology, Pittsburgh PA, USA
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17
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Ouzaid I, Capitanio U, Staehler M, Wood CG, Leibovich BC, Ljungberg B, Van Poppel H, Bensalah K. Surgical Metastasectomy in Renal Cell Carcinoma: A Systematic Review. Eur Urol Oncol 2018; 2:141-149. [PMID: 31017089 DOI: 10.1016/j.euo.2018.08.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/02/2018] [Accepted: 08/31/2018] [Indexed: 02/07/2023]
Abstract
CONTEXT The benefit of surgical metastasectomy (SM) for patients with metastatic renal cell carcinoma (mRCC) remains controversial because of the lack of high-level evidence on the role of SM in terms of survival benefit in the era of systemic therapy. OBJECTIVE To perform a systematic review of the literature on the role of SM in the treatment of mRCC and discuss key issues in the SM decision-making process. EVIDENCE ACQUISITION A systematic search of the Embase and Medline databases was carried out and a systematic review of the role of SM in mRCC was performed. A total of 56 studies were finally included in the evidence synthesis. EVIDENCE SYNTHESIS All the studies included were retrospective and mostly noncomparative. Median overall survival (OS) ranged from 36 to 142mo for those undergoing SM, compared to 8-27mo for no SM. SM was associated with a lower risk of all-cause mortality compared to no SM (pooled adjusted hazard ratio 2.37, 95% confidence interval 2.03-2.87; p<0.001). Morbidity and mortality were similar for SM and primary tumor surgery. The most important prognostic factor for OS was complete resection of metastases. Other prognostic factors included disease free-survival from nephrectomy, primary tumor features (T stage ≥3, high grade, sarcomatoid features, and pathological nodal status), the number of metastases, and performance status. Lung metastasectomy seemed to show the best survival benefit. CONCLUSIONS Although no randomized clinical data are available, published studies support the role of SM in selected patients in the modern era. Complete SM allows sustained survival free of systemic treatment. Integration of SM and systemic therapy in a multimodal approach remains a valid option for some patients. PATIENT SUMMARY Surgical resection of metastases originating from renal cell carcinoma may play a role in prolonging survival and avoiding systemic therapy when complete resection is achievable. This strategy is an option for selected patients with a limited number of metastases who still have good general health status.
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Affiliation(s)
- Idir Ouzaid
- Department of Urology, Hôpital Bichat Claude Bernard, Paris Diderot University, Paris, France
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute and Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Christopher G Wood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Hendrik Van Poppel
- Department of Urology, University Hospitals of KU Leuven, Leuven, Belgium
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
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18
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Abstract
BACKGROUND In patients with isolated meta- or synchronous pulmonary metastases from renal cell cancer, lung metastasectomy could be an appropriate treatment option after successful treatment of primary cancer. OBJECTIVES Presentation of lung metastasectomy as a treatment option in patients with pulmonary metastatic renal cell cancer and the postoperative outcome. Description of alternative treatment modalities focusing on "targeted therapies". MATERIALS AND METHODS Systematical literature research and qualitative analysis of studies on patients undergoing lung metastasectomy after primary nephrectomy published since 01 January 2000. We assessed operative findings, survival data, and prognostic factors. RESULTS Pulmonary metastasectomy results in a median postmetastasectomy survival of 26-94 months. The 5‑year survival rates vary between 33 and 58%. The patients' prognosis depends on a prolonged disease-free interval and complete resection of all suspected metastases. In particular, number and location of lung metastases should play a minor role for the indication for lung metastasectomy. CONCLUSIONS Pulmonary metastasectomy should be considered the treatment of choice in selected patients with successfully resected primary cancer showing no evidence of extrapulmonary metastases and having guaranteed operability and complete resection.
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19
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Treatments, Outcomes, and Validity of Prognostic Scores in Patients With Sarcomatoid Renal Cell Carcinoma: A 20-Year Single-Institution Experience. Clin Genitourin Cancer 2018; 16:e577-e586. [DOI: 10.1016/j.clgc.2017.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/29/2017] [Accepted: 12/15/2017] [Indexed: 11/23/2022]
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20
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Hoerner-Rieber J, Duma M, Blanck O, Hildebrandt G, Wittig A, Lohaus F, Flentje M, Mantel F, Krempien R, Eble MJ, Kahl KH, Boda-Heggemann J, Rieken S, Guckenberger M. Stereotactic body radiotherapy (SBRT) for pulmonary metastases from renal cell carcinoma-a multicenter analysis of the German working group "Stereotactic Radiotherapy". J Thorac Dis 2017; 9:4512-4522. [PMID: 29268521 DOI: 10.21037/jtd.2017.10.108] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Renal cell carcinoma (RCC) is traditionally considered to be radioresistant. Radiotherapy response rates are believed to improve with hypofractionated, high dose stereotactic body radiotherapy (SBRT). However, limited data exist regarding the role of SBRT in the treatment of pulmonary metastases. Methods The working group "Stereotactic Radiotherapy" of the German Society of Radiation Oncology analyzed its multi-institutional database of more than 700 patients who received SBRT for pulmonary metastases. Treatment was performed at 10 centers between 2001 and 2016. Patients with metastatic RCC were included in the study. Tumor characteristics, treatment details, and follow-up data including survival, local control (LC), distant metastases, and toxicity were evaluated. Results A total of 46 RCC patients treated with SBRT for 67 lung metastases were identified, who received a median total biologically effective dose (BEDiso) at planning target volume (PTV) isocenter of 117.0 Gy (range, 48.0-189.0 Gy). A median fractional dose of 20.8 Gy at isocenter (range, 6.0-37.9 Gy) was administered in a median number of 3 fractions (1-8 fractions). After a median follow-up time of 28.3 months for all patients, 1- and 3-year LC rates were 98.1% and 91.9%, with corresponding 1- and 3-year overall survival (OS) of 84.3% and 43.8%, respectively. Pulmonary metastases treated with BEDiso ≥130 Gy showed a trend for superior LC (P=0.054). OS was significantly improved in both uni- and multivariate analysis for patients with higher Karnofsky performance scale, lower maximum pulmonary metastasis diameter and lack of post-SBRT systemic therapy due to progression (P=0.014; P=0.049; P=0.006). Only mild acute and late toxicity was reported. Conclusions SBRT for pulmonary metastases from RCC was associated with low treatment-associated toxicity, promising survival, and excellent LC, especially in those patients receiving a BEDiso ≥130 Gy.
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Affiliation(s)
- Juliane Hoerner-Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Marciana Duma
- Department of Radiation Oncology, Technical University Munich, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Guido Hildebrandt
- Department of Radiation Oncology, University of Rostock, Rostock, Germany
| | - Andrea Wittig
- Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Germany
| | - Fabian Lohaus
- Department of Radiation Oncology, Medical Faculty and University Hospital C.G. Carus, Technical University Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK) partner site Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, Germany
| | - Frederick Mantel
- Department of Radiation Oncology, University Hospital Wuerzburg, Germany
| | - Robert Krempien
- Department of Radiation Oncology, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Michael J Eble
- Department of Radiation Oncology, University Hospital Aachen, Aachen, Germany
| | | | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
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21
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Patrini D, Panagiotopoulos N, Lawrence D, Scarci M. Surgical management of lung metastases. Br J Hosp Med (Lond) 2017; 78:192-198. [PMID: 28398890 DOI: 10.12968/hmed.2017.78.4.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of pulmonary metastases has evolved considerably over the last few decades but is still controversial. The surgical management of lung metastases is outlined, discussing the preoperative management, indications for surgery, the surgical approach and outcomes according to the primary histology.
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Affiliation(s)
- Davide Patrini
- Senior Registrar in Thoracic Surgery, Thoracic Surgery Department, University College London Hospitals, London W1G 8PH
| | - Nikolaos Panagiotopoulos
- Consultant Thoracic Surgeon, Thoracic Surgery Department, University College London Hospitals, London
| | - David Lawrence
- Consultant Cardiothoracic Surgeon, Thoracic Surgery Department, University College London Hospitals, London
| | - Marco Scarci
- Consultant Thoracic Surgeon, Thoracic Surgery Department, University College London Hospitals, London
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22
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Prognostic factors for overall survival after lung metastasectomy in renal cell cancer patients: A systematic review and meta-analysis. Int J Surg 2017; 41:70-77. [PMID: 28351779 DOI: 10.1016/j.ijsu.2017.03.062] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pulmonary metastasis of Renal cell carcinomas (RCC) is usually considered as a systemic disease. However, some studies revealed potential survival benefits of pulmonary metastasectomies for such patients. The aim of this study was to conduct a systematic review and meta-analysis to assess the prognostic factors for pulmonary metastasectomy of RCC patients. METHODS An electronic search in MEDLINE, EMBASE, CENTRAL and Chinese BioMedical Literature Database (CBM) were conducted to identify eligible studies. We combined the hazard ratios (HRs) of the identified prognostic factors for overall survival of RCC patients after pulmonary metastasectomy from the eligible studies. RESULTS Sixteen studies with a total of 1447 patients were included in this meta-analysis. The pooled 1, 3, 5, 10-year overall survival rates for RCC patient after pulmonary metastasectomy were 84%, 59%, 43% and 20%, respectively. The poor prognostic factors were lymph node involvement (LNI) of primary RCC (HR 3.44, 95% confidence interval (CI) 1.78-6.67, P = 0.001), incomplete resection of metastases (HR 3.74, 95% CI 2.49-5.61, P = 0.000), multiple metastases (HR 1.55, 95% CI 1.18-2.03, P = 0.002), larger metastases (HR 1.45, 95% CI 1.26-1.66, P = 0.000), LNI of metastases (HR 3.06, 95% CI 1.52-6.19, P = 0.002), synchronous metastasis (HR 2.49, 95% CI 1.46-4.24, P = 0.001) and short disease free interval (DFI). CONCLUSIONS Surgery may be a promising treatment for pulmonary metastases of RCC patients. A short DFI, LNI of primary RCC, incomplete resection of metastases, multiple metastases, larger metastases, LNI of metastases and synchronous metastasis are predictors of poor survival after pulmonary metastasectomy for RCC patients.
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23
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Burger M. [Is surgical treatment ever indicated in metastatic renal cell carcinoma and if so, based on which scientific rationale?]. Urologe A 2017; 56:617-623. [PMID: 28314970 DOI: 10.1007/s00120-017-0357-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Metastasis is a common event in renal cell carcinoma. Surgical resection of metastases may be feasible in two scenarios: aiming at palliation, which may be feasible due to reduced radiosensitivity of renal cell cancer, and aiming at prolonging survival, which may be feasible given the rather good prognosis of some patterns of metastasis. OBJECTIVE This review intends to reflect on current evidence for surgical resection of metastases in both scenarios. The literature was searched in PubMed and respective guidelines were reviewed. RESULTS AND CONCLUSIONS Palliative resection is mainly feasible to control symptoms like spinal compression; adjuvant radiation is advisable. Resection is markedly feasible, however, for improvement of cancer-specific survival in probably all resectable patterns of metastasis-solitary, multiple, syn- and metachronous, and in all organs-provided complete resection can be achieved. A fairly good prognosis is seen in solitary pulmonary metastasis without concomitant hilar or mediastinal lymph node metastasis and a metachronous appearance following long recurrence-free survival after tumor nephrectomy; complete resection may be considered curative in certain cases. Neo- or adjuvant medical therapy or radiation is not established. In cases lacking complete resectability, stereotactic radiation may be considered as an alternative.
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Affiliation(s)
- M Burger
- Klinik für Urologie Lehrstuhl der Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland.
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24
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The predictive accuracy of sentinel nodes mapping in the setting of pulmonary metastasectomy. Clin Exp Metastasis 2017; 34:125-131. [PMID: 28062976 PMCID: PMC5337247 DOI: 10.1007/s10585-016-9834-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/28/2016] [Indexed: 02/07/2023]
Abstract
This is the first study to evaluate the feasibility of mediastinal lymph node dissection (MLND) based on sentinel lymph node (SLN) status during pulmonary metastasectomy. A total of 22 patients (16 men, 6 women; age 63.3 ± 7.01 years) who were candidates for metastasectomy through segmentectomy or lobectomy with MLND owing to cancers metastatic to the lung were enrolled in this study. Radiotracer was administered at the peritumoral region before surgery or soon after initiating surgery. During the operation, the radioactivity of the lymph nodes (ex vivo) was counted with a handheld gamma probe after MLND. Lobectomy was performed in 17 patients, and segmentectomy, in 5 patients. The number of dissected lymph nodes per patient was 14.4 ± 8.69 (range, 5–36). In all patients, the SLN could be detected, and the number of SLNs identified was 2.0 ± 1.15 (range, 1–5) per patient. Lymph node metastasis was identified in 3 of the 22 patients (13.6%), and none of the 3 patients with N1 or N2 disease had false-negative SLNs. SLN identification might be an indicator of whether or not MLND should be performed during pulmonary metastasectomy. However, further large-volume and multi-institutional studies are needed.
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25
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26
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Dziedzic D, Peryt A, Szolkowska M, Langfort R, Orlowski T. Evaluation of the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration for metastatic mediastinal tumors. Endosc Ultrasound 2016; 5:173-7. [PMID: 27386474 PMCID: PMC4918300 DOI: 10.4103/2303-9027.183973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives: The mediastinum is a relatively uncommon site of distant metastases, which typically appear as peripheral lung nodules. We chose to assess the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of distant metastases to the mediastinum. Materials and Methods: Over the period 2008–2013, a total of 446 patients with concurrent or previously diagnosed and treated extrathoracic malignancies were evaluated. Results: Surgical treatment was carried out in 414 patients (156 women and 237 men aged 26–68 years, mean age of 56.5 years) presenting with distant metastases to the lungs: Thoracoscopic wedge resection was completed in 393 patients and lobectomy and segmentectomy were performed in 7 and 14 patients, respectively. The median time from primary tumor resection was 6.5 years (range: 4.5 months to 17 years). Thirty-two of these patients underwent EBUS-TBNA for mediastinal manifestation of the underlying disease. EBUS-TBNA specimens were aspirated from the subcarinal or right paratracheal lymph node stations in 26 (81%) patients and from the hilar lymph nodes in 6 (18.8%) patients only. Metastases to lymph nodes were confirmed in 14 of these patients (43.8%). Primary lung cancer was diagnosed in seven patients. Mediastinoscopy was performed in two patients to reveal either lymph node metastasis or sarcoidosis. Thoracotomy for pulmonary metastases resection and mediastinal lymph node biopsy was performed in nine patients. Lymph node metastasis was confirmed in five patients (15.6%). The diagnostic efficacy, sensitivity, specificity, and negative predictive value (NPV) of EBUS-TBNA were 78.8%, 93.3%, 100%, and 87.5%, respectively. Conclusion: EBUS-TBNA is a valuable diagnostic tool in a selected group of patients with secondary tumors in the mediastinum and lungs.
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Affiliation(s)
- Dariusz Dziedzic
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Adam Peryt
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Malgorzata Szolkowska
- Department of Patomorphology, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Renata Langfort
- Department of Patomorphology, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Tadeusz Orlowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
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Abstract
Pulmonary metastasectomy continues to be an effective approach to prolong survival in appropriately selected patients. The incidence of lymphatic spread is more common than previously recognized, with an estimate of 20% to 25% across multiple tumor types. The presence of metastatically involved lymph nodes adversely affects survival. What remains unclear is whether N1 vs N2, or the number of stations involved affects survival differently. The role of surgery for pulmonary metastasectomy in the patient with nodal metastases will likely expand with ongoing improvements in targeted and immunotherapies.
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Affiliation(s)
- James Matthew Reinersman
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP 2230, Oklahoma City, OK 73104, USA
| | - Dennis A Wigle
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Sponholz S, Schirren M, Kudelin N, Knöchlein E, Schirren J. Results of Pulmonary Resection. Thorac Surg Clin 2016; 26:99-108. [DOI: 10.1016/j.thorsurg.2015.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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29
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Affiliation(s)
- Ikenna Okereke
- Thoracic Surgery, University of Texas Medical Branch, Galveston, TX 77551
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30
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Mineo TC, Ambrogi V. Lung metastasectomy: an experience-based therapeutic option. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:194. [PMID: 26417578 DOI: 10.3978/j.issn.2305-5839.2015.08.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Tommaso Claudio Mineo
- Thoracic Surgery Department, Tor Vergata University, Tor Vergata Policlinico, viale Oxford 81, 00133 Rome, Italy
| | - Vincenzo Ambrogi
- Thoracic Surgery Department, Tor Vergata University, Tor Vergata Policlinico, viale Oxford 81, 00133 Rome, Italy
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31
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New Challenges in Kidney Cancer Management: Integration of Surgery and Novel Therapies. Curr Treat Options Oncol 2015; 16:337. [DOI: 10.1007/s11864-015-0337-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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32
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Dabestani S, Bex A. Metastasectomy. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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33
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Merseburger A, Kuczyk M, Haverich A, Krüger M. Metastasenchirurgie beim Nierenzellkarzinom. DER ONKOLOGE 2014. [DOI: 10.1007/s00761-014-2775-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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