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Baum D, Rolle A, Koschel D, Rostock L, Decker R, Sombati M, Öhme F, Plönes T. Long-Term Follow-Up after Laser-Assisted Pulmonary Metastasectomy Shows Complete Lung Function Recovery. Cancers (Basel) 2024; 16:1762. [PMID: 38730714 PMCID: PMC11083535 DOI: 10.3390/cancers16091762] [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: 04/12/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Preserving maximum lung function is a fundamental goal of parenchymal-sparing pulmonary laser surgery. Long-term studies for follow-up of lung function after pulmonary laser metastasectomy are lacking. However, a sufficient postoperative lung function is essential for quality of life and reduces potential postoperative complications. In this study, we investigate the extent of loss in lung function following pulmonary laser resection after three, six, and twelve months. We conducted a retrospective analysis using a prospective database of 4595 patients, focusing on 126 patients who underwent unilateral pulmonary laser resection for lung metastases from 1996 to 2022 using a 1318 nm Nd:YAG laser or a high-power pure diode laser. Results show that from these patients, a median of three pulmonary nodules were removed, with 75% presenting central lung lesions and 25% peripheral lesions. The median preoperative FEV1 was 98% of the predicted value, decreasing to 71% postoperatively but improving to 90% after three months, 93% after six months, and 96% after twelve months. Statistical analysis using the Friedman test indicated no significant difference in FEV1 between preoperative levels and those at six and twelve months post-surgery. The findings confirm that pulmonary laser surgery effectively preserves lung function over time, with patients generally regaining their preoperative lung function within a year, regardless of the metastases' location.
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Affiliation(s)
- Daniel Baum
- Department of Thoracic Surgery, Fachkrankenhaus Coswig, Lung Center, Neucoswiger Str. 21, 01640 Coswig, Germany
| | - Axel Rolle
- Department of Thoracic Surgery, Fachkrankenhaus Coswig, Lung Center, Neucoswiger Str. 21, 01640 Coswig, Germany
| | - Dirk Koschel
- Division of Pneumology, Medical Department I, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstr. 74, 01307 Dresden, Germany
- Department of Internal Medicine and Pneumology, Fachkrankenhaus Coswig, Lung Center, Neucoswiger Str. 21, 01640 Coswig, Germany
| | - Lysann Rostock
- Department of Thoracic Surgery, Fachkrankenhaus Coswig, Lung Center, Neucoswiger Str. 21, 01640 Coswig, Germany
| | - Rahel Decker
- Department of Thoracic Surgery, Fachkrankenhaus Coswig, Lung Center, Neucoswiger Str. 21, 01640 Coswig, Germany
- Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstr. 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC Dresden), Fetscherstraße 74, 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, 01069 Dresden, Germany
- Helmholtz-Zentrum Dresden—Rossendorf (HZDR), 01328 Dresden, Germany
| | - Monika Sombati
- Department of Thoracic Surgery, Fachkrankenhaus Coswig, Lung Center, Neucoswiger Str. 21, 01640 Coswig, Germany
| | - Florian Öhme
- National Center for Tumor Diseases (NCT/UCC Dresden), Fetscherstraße 74, 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, 01069 Dresden, Germany
- Helmholtz-Zentrum Dresden—Rossendorf (HZDR), 01328 Dresden, Germany
- Division of Visceral Surgery, Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstr. 74, 01307 Dresden, Germany
| | - Till Plönes
- Department of Thoracic Surgery, Fachkrankenhaus Coswig, Lung Center, Neucoswiger Str. 21, 01640 Coswig, Germany
- Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstr. 74, 01307 Dresden, Germany
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2
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Yamauchi Y, Nakajima J, Mun M, Shintani Y, Kuroda H, Iwata T, Endo M, Azuma Y, Chida M, Sakao Y, Yoshino I, Ikeda N, Matsuguma H, Funai K, Hashimoto H, Kawamura M. Survival after Lung Metastasectomy from Esophageal Cancer: Results from a Multi-Institutional Database. Cancers (Basel) 2023; 15:cancers15051472. [PMID: 36900265 PMCID: PMC10000551 DOI: 10.3390/cancers15051472] [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: 12/19/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
To clarify the clinical impact and to identify prognostic predictors of surgical intervention for pulmonary metastasis from esophageal cancer, a registry database analysis was performed. From January 2000 to March 2020, patients who underwent resection of pulmonary metastases from primary esophageal cancer at 18 institutions were registered in a database developed by the Metastatic Lung Tumor Study Group of Japan. An amount of 109 cases were reviewed and examined for the prognostic factors for pulmonary metastasectomy of metastases from esophageal cancer. As a result, five-year overall survival after pulmonary metastasectomy was 34.4% and five-year disease-free survival was 22.1%. The multivariate analysis for overall survival revealed that initial recurrence site, maximum tumor size, and duration from primary tumor treatment to lung surgery were selected as the significant prognostic factors (p = 0.043, p = 0.048, and p = 0.037, respectively). In addition, from the results of the multivariate analysis for disease free survival, number of lung metastases, initial recurrence site, duration from primary tumor treatment to lung surgery, and preoperative chemotherapy for lung metastasis were selected as the significant prognostic factors (p = 0.037, p = 0.008, p = 0.010, and p = 0.020, respectively). In conclusion, eligible patients with pulmonary metastasis from esophageal cancer selected based on the identified prognostic predictors would be good candidates for pulmonary metastasectomy.
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Affiliation(s)
- Yoshikane Yamauchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo 170-8582, Japan
- Correspondence: ; Tel.: +81-3-3964-1211
| | - Jun Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Tokyo 135-8550, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Takekazu Iwata
- Department of Thoracic Surgery, Chiba Cancer Center, Chiba 260-8670, Japan
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, School of Medicine, Toho University, Tokyo 143-8541, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu 321-0293, Japan
| | - Yukinori Sakao
- Department of Surgery, Teikyo University School of Medicine, Tokyo 170-8582, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Haruhisa Matsuguma
- Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya 320-0834, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Hiroshi Hashimoto
- Department of Thoracic Surgery, National Defense Medical College, Saitama 359-8513, Japan
| | - Masafumi Kawamura
- Department of Surgery, Teikyo University School of Medicine, Tokyo 170-8582, Japan
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Garcia-Exposito N, Ramos R, Navarro-Perez V, Molina K, Arnaiz MD, Padrones S, Ruffinelli JC, Santos C, Guedea F, Navarro-Martin A. Stereotactic Body Radiotherapy versus Surgery for Lung Metastases from Colorectal Cancer: Single-Institution Results. Cancers (Basel) 2023; 15:cancers15041195. [PMID: 36831537 PMCID: PMC9954242 DOI: 10.3390/cancers15041195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Surgery and stereotactic body radiotherapy (SBRT) are two of the options available as local treatments for pulmonary oligometastases from colorectal cancer (CRC). We hypothesized that SBRT would have, at least, a similar local control rate to surgery. METHODS We identified an initial cohort of 100 patients with CRC who received SBRT or surgery for lung metastases. This was then narrowed down to 75 patients: those who underwent surgery (n = 50) or SBRT (n = 25) as their first local thoracic treatment between 1 January 2004 and 29 December 2017. The Kaplan-Meier method was used to calculate lung-progression-free survival (L-PFS) and overall survival (OS). RESULTS The 1 and 2-year L-PFS was 85% and 70% in the surgical group and 87% and 71% in the SBRT group, respectively (p = 0.809). No significant differences were found between the two groups in terms of OS. The biologically effective dose (BED), age and initial CRC stage did not have a significant effect on local control or survival. No grade 3 or above acute- or late-toxicity events were reported. CONCLUSIONS These results add retrospective evidence that SBRT and surgery have similar results in terms of OS and local control in patients with lung oligometastases from CRC.
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Affiliation(s)
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDI-BELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Valentin Navarro-Perez
- Clinical Research Unit, Institut Català d’Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Kevin Molina
- Medical Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Maria Dolores Arnaiz
- Radiation Oncology Department, Institut Català d’Oncologia, 08908 Barcelona, Spain
| | - Susana Padrones
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Jose Carlos Ruffinelli
- Medical Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Cristina Santos
- Medical Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d’Oncologia, 08908 Barcelona, Spain
| | - Arturo Navarro-Martin
- Radiation Oncology Department, Institut Català d’Oncologia, 08908 Barcelona, Spain
- Correspondence:
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Motas N, Davidescu MD, Tanase BC, Rus O, Burlacu AI, Alexe V, Manolache V, Mizea MC, Gheorghiu N, Trifanescu OG, Gales LN, Horvat T, Anghel RM. Oncologic Outcome after Pulmonary Metastasectomy as Part of Multidisciplinary Treatment in a Tertiary Oncological Center. Diagnostics (Basel) 2023; 13:diagnostics13010165. [PMID: 36611457 PMCID: PMC9818764 DOI: 10.3390/diagnostics13010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
(1) Background: Pulmonary metastases are encountered in approximately one-third of patients with malignancies, especially from colorectal, lung, breast, and renal cancers, and sarcomas. Pulmonary metastasectomy is the ablative approach of choice, when possible, as part of the multidisciplinary effort to integrate and personalize the oncological treatment. (2) Methods: The study includes 58 consecutive cases of pulmonary metastasectomies, retrospectively analyzed, performed in 12 consecutive months, in which the pathology reports confirmed lung metastases. (3) Results: Most frequent pathological types of metastases were: 14 of colorectal cancer, 10 breast, 8 lung, and 8 sarcomas. At the time of primary cancer diagnosis, 14 patients (24.14%) were in the metastatic stage. The surgical approach was minimally invasive through uniportal VATS (Video-Assisted Thoracic Surgery) in 3/4 of cases (43 patients, 74%). Almost 20% of resections were typical (lobectomy, segmentectomy). Lymphadenectomy was associated in almost 1/2 of patients and lymph node metastases were found in 11.11% of cases. The mortality rate (intraoperative and 90 days postoperative) is zero. The OS after pulmonary metastasectomy is 87% at 18 months, and the estimated OS for cancer is 90% at 5 years. The worst outcome presents the patients with sarcomas and the best outcome-colorectal and lung cancer. The patients with 1 or 2 resected metastases presented 96% survival at 24 months. (4) Conclusions: After pulmonary metastasectomy, survival is favored by the small number of metastases resected (1 or 2), and by the dimension of metastases under 20.5 mm. The non-anatomic (wedge) type of lung resection may present a lower risk of death compared to lobectomy. No statistical significance on survival has the presence of lymphadenectomy, the laterality right/left lung, the upper/lower lobes. In the future, longer follow-up and prospective randomized trials are needed for drawing definitive conclusions.
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Affiliation(s)
- Natalia Motas
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
- Correspondence: (N.M.); (M.D.D.)
| | - Mihnea Dan Davidescu
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
- Correspondence: (N.M.); (M.D.D.)
| | - Bogdan Cosmin Tanase
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Ovidiu Rus
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Alin Ionut Burlacu
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Vlad Alexe
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Veronica Manolache
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, Memorial Oncology Hospital, Șoseaua Gheorghe Ionescu Sisești 8a, 013812 Bucharest, Romania
| | - Madalina Cristiana Mizea
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Nicolae Gheorghiu
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Oana Gabriela Trifanescu
- Clinic of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Laurentia Nicoleta Gales
- Clinic of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Teodor Horvat
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Rodica Maricela Anghel
- Clinic of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
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5
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Chandarana K, Caruana EJ, Weaver H, Rathinam S, Nakas A. Laser pulmonary metastasectomy preserves parenchyma: a single-centre retrospective study from the United Kingdom. THE CARDIOTHORACIC SURGEON 2022. [DOI: 10.1186/s43057-022-00088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Abstract
Background
Pulmonary metastasectomy (PME) is a modality increasingly employed to control oligometastatic disease from a variety of solid tumours.
We present data from a single UK centre, following the introduction of laser-assisted surgery (LAS) using the Limax® 120 Nd:Yag laser (Gebrüder Martin GmbH & Co. KG, Tuttlingen, Germany).
Methods
All patients undergoing PME between September 2015 and August 2018 were included in our study. Those undergoing LAS were compared to a control of conventional stapled wedge metastasectomy (SWM). Data was analysed retrospectively from a prospective kept database. Statistical analysis was performed using JASP (Version 0.14.1).
Results
Fifty-seven procedures in 46 patients, were included in the final analysis. Demographic data was similar at baseline between the LAS and SWM group, with colorectal cancer being the most common primary, 44/57 (77%). LAS was favoured in patients who had previously undergone pulmonary metastasectomy, 9/12 (75%). Patients in the LAS group had a smaller parenchymal volume resected (MD 30.6 cm3, p = 0.0084), with a lower incidence of clear histological marginal resection (11/27 vs 29/30, p < 0.0001); but no difference in operative time, morbidity, patient-reported outcome measures, or local recurrence between the two groups at 2 years. LAS was associated with a lower procedural cost (MD £452.92, p < 0.0001).
Conclusions
Laser-assisted pulmonary metastasectomy presents a safe and acceptable alternative to traditional stapled wedge resection, with notable parenchymal-sparing, no discernible learning curve, and lower direct costs.
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Lee RM, Ethun CG, Gamboa AC, Turgeon MK, Tran T, Poultsides G, Grignol V, Bedi M, Mogal H, Clarke CN, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Krasnick BA, Fields RC, Oskouei SV, Monson DK, Reimer NB, Maithel SK, Pickens A, Cardona K. A novel preoperative risk score to guide patient selection for resection of soft tissue sarcoma lung metastases: An analysis from the United States Sarcoma Collaborative. J Surg Oncol 2021; 124:1477-1484. [PMID: 34374088 DOI: 10.1002/jso.26635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Surgical resection for sarcoma lung metastases has been associated with improved overall survival (OS). METHODS Patients who underwent curative-intent resection of sarcoma lung metastases (2000-2016) were identified from the US Sarcoma Collaborative. Patients with extrapulmonary metastatic disease or R2 resections of primary tumor or metastases were excluded. Primary endpoint was OS. RESULTS Three hundred and fifty-two patients met inclusion criteria. Location of primary tumor was truncal/extremity in 85% (n = 270) and retroperitoneal in 15% (n = 49). Forty-nine percent (n = 171) of patients had solitary and 51% (n = 180) had multiple lung metastasis. Median OS was 49 months; 5-year OS 42%. Age ≥55 (HR 1.77), retroperitoneal primary (HR 1.67), R1 resection of primary (HR 1.72), and multiple (≥2) lung metastases (HR 1.77) were associated with decreased OS(all p < 0.05). Assigning one point for each factor, we developed a risk score from 0 to 4. Patients were then divided into two risk groups: low (0-1 factor) and high (2-4 factors). The low-risk group (n = 159) had significantly better 5-year OS compared to the high-risk group (n = 108) (51% vs. 16%, p < 0.001). CONCLUSION We identified four characteristics that in aggregate portend a worse OS and created a novel prognostic risk score for patients with sarcoma lung metastases. Given that patients in the high-risk group have a projected OS of <20% at 5 years, this risk score, after external validation, will be an important tool to aid in preoperative counseling and consideration for multimodal therapy.
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Affiliation(s)
- Rachel M Lee
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Cecilia G Ethun
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Adriana C Gamboa
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Michael K Turgeon
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Valerie Grignol
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Harveshp Mogal
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Callisia N Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | - Bradley A Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Shervin V Oskouei
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - David K Monson
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Nickolas B Reimer
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Shishir K Maithel
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Allan Pickens
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA
| | - Kenneth Cardona
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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7
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The Diagnostic Value of FDG PET/CT and Thin-Slice High-Resolution Chest CT in Pulmonary Intravascular Metastasis. AJR Am J Roentgenol 2021; 216:769-775. [PMID: 33405948 DOI: 10.2214/ajr.20.23017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Pulmonary intravascular metastasis is a special type of pulmonary metastasis of malignancies; however, few relevant studies have been performed. This study aimed to determine the characteristics of pulmonary intravascular metastasis and improve understanding of the disease by retrospective analysis of FDG PET/CT and thin-layer high-resolution CT (HRCT) imaging of the chest in patients with tumors. MATERIALS AND METHODS. We identified all patients who underwent FDG PET/CT at two hospitals between January 2016 and February 2019 and conducted a comparative analysis of HRCT and PET/CT images. In total, 84 patients (38 women and 46 men) ranging in age from 35 to 82 years old (mean age, 54.7 ± 14.5 [SD] years) participated in the study. Patient characteristics were summarized, and diagnosis was confirmed by chest CT or PET/CT follow-up. RESULTS. A total of 260 pulmonary intravascular metastases were found, which were classified as type I (no significant abnormality, n = 5), type II (abrupt and uneven thickening of the pulmonary vessel, n = 118), type III (simultaneous invasion of adjacent pulmonary vessel, n = 121), and type IV (large strip-shaped high-density mass, n = 16). The majority were located in peripheral pulmonary vessels (94.2% [245/260]). FDG up-take was increased in 252 lesions, and the mean SUVmax was 4.6 ± 2.5. CONCLUSION. The combination of PET/CT and chest HRCT is an effective approach for detecting pulmonary intravascular metastasis. The linear pattern of FDG uptake, abnormal pulmonary blood vessel morphology, and location (below the lung segment) are specific indicators for the diagnosis of pulmonary intravascular metastasis and should be recognized by clinicians and radiologists.
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8
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Moneke I, Funcke F, Schmid S, Osei-Agyemang T, Passlick B. Pulmonary laser-assisted metastasectomy is associated with prolonged survival in patients with colorectal cancer. J Thorac Dis 2019; 11:3241-3249. [PMID: 31559026 DOI: 10.21037/jtd.2019.08.73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Pulmonary metastases develop in 10-15% of patients with colorectal cancer. Surgical metastasectomy currently provides the only hope for a cure for these patients. The aim of this study was to analyze the expanding role of pulmonary metastasectomy in the context of laser-assisted surgery (LAS) vs. non-laser-assisted surgery (NLAS). Methods We performed a single-center retrospective analysis of 204 patients who underwent curative pulmonary metastasectomy for colorectal cancer between 01/2005 and 12/2016. The main endpoint was survival. The Kaplan-Meier method was applied for statistical analysis and survival rates were compared with the log rank test. Results Median follow-up was 53 months. A total of 267 metastases were resected in 154 operations in the NLAS group (median: 1) vs. 438 metastases in 122 operations in the LAS group (median: 5; P<0.0001). The interval between treatment of the primary tumor and the first pulmonary metastasectomy was significantly shorter in the LAS group (19 vs. 32 months; P=0.008). Anatomical resections were significantly reduced using LAS, 8% vs. 23% respectively. Despite more negative predictors in the LAS group, there was no statistically significant difference in overall disease-specific 5-year survival (70% LAS vs. 58% NLAS; P=0.18). Conclusions Survival after pulmonary metastasectomy has previously been shown to correlate with a low number of metastases and a longer disease-free interval. However, with the tissue-saving LAS technique complete resectability can be achieved in patients with more metastases and long-term survival is possible for selected patients.
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Affiliation(s)
- Isabelle Moneke
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany.,Division of Cancer Research, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany
| | - Friederike Funcke
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany
| | - Severin Schmid
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany
| | - Thomas Osei-Agyemang
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
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9
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Moneke I, Kaifi JT, Kloeser R, Samson P, Haager B, Wiesemann S, Diederichs S, Passlick B. Pulmonary metastasectomy for thyroid cancer as salvage therapy for radioactive iodine-refractory metastases. Eur J Cardiothorac Surg 2019; 53:625-630. [PMID: 29092022 DOI: 10.1093/ejcts/ezx367] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 09/21/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Distant metastasis arising from thyroid cancer is rare but has been associated with significantly reduced long-term survival, especially when refractory to radioactive iodine ablation. We provide one of the largest studies worldwide reporting the outcome after salvage pulmonary metastasectomy for this entity, aiming to identify prognostic factors and to analyse surgical indication. METHODS We retrospectively analysed the medical records of 43 patients who had undergone pulmonary metastasectomy for radioactive iodine-refractory thyroid cancer from 1985 to 2016. RESULTS The median follow-up period was 77 (95% confidence interval 41-113) months. Twenty-three (53%) patients were alive at the time of analysis. The majority of tumours were follicular thyroid cancer by histology, with 23% identified as Hurthle cell subtype. Five- and 10-year disease-specific (DS) survival was 84% and 59%, respectively. Thirty-one (72%) patients underwent R0-resection with a 5- and 10-year DS survival of 100% and 77%, respectively. This was significantly reduced to 62% and 22% (P = 0.013) in case of incomplete resection, respectively. Ten years after R0-metastasectomy, 17 (55%) patients were recurrence-free. Systematic mediastinal lymphadenectomy was performed in 16 (37%) patients and was associated with improved long-term DS survival (10 years 88% vs 46%, P = 0.034). Moreover, a reduction of > 80% in serum thyroglobulin levels post-metastasectomy correlates with better long-term DS survival (10 years 81% vs 36%, P = 0.007). CONCLUSIONS Pulmonary metastasectomy is associated with good survival for selected patients with radioactive iodine-refractory metastases of differentiated thyroid cancer, especially if R0-resection can be achieved. Moreover, it is worth considering whether a significant reduction of tumour load, as indicated by thyroglobulin serum levels, seems possible.
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Affiliation(s)
- Isabelle Moneke
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Division of Cancer Research, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany
| | - Jussuf T Kaifi
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Raphael Kloeser
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick Samson
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt Haager
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven Diederichs
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Division of Cancer Research, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany.,Division of RNA Biology and Cancer, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Germany
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10
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Handy JR, Bremner RM, Crocenzi TS, Detterbeck FC, Fernando HC, Fidias PM, Firestone S, Johnstone CA, Lanuti M, Litle VR, Kesler KA, Mitchell JD, Pass HI, Ross HJ, Varghese TK. Expert Consensus Document on Pulmonary Metastasectomy. Ann Thorac Surg 2018; 107:631-649. [PMID: 30476477 DOI: 10.1016/j.athoracsur.2018.10.028] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 12/17/2022]
Affiliation(s)
- John R Handy
- Thoracic Surgery, Providence Health & Services, Portland, Oregon.
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Todd S Crocenzi
- Medical Oncology, Providence Cancer Center, Providence Health & Services, Portland, Oregon
| | - Frank C Detterbeck
- Section of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Hiran C Fernando
- Inova Cardiac and Thoracic Surgery, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Panos M Fidias
- Medical Oncology, Center for Cancer Care, Exeter Hospital, Exeter, New Hampshire
| | | | - Candice A Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Lanuti
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Virginia R Litle
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Kenneth A Kesler
- Section of Thoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, Langone Medical Center, New York University School of Medicine, New York, New York
| | - Helen J Ross
- Division of Hematology/Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | - Thomas K Varghese
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
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11
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Shiono S, Endo M, Suzuki K, Yarimizu K, Hayasaka K. The prognostic value of positron emission tomography/computed tomography in pulmonary metastasectomy. J Thorac Dis 2018; 10:1738-1746. [PMID: 29707328 DOI: 10.21037/jtd.2018.02.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Although positron emission tomography/computed tomography (PET/CT) findings are prognostic in lung cancer patients, the prognostic value of PET/CT findings in patients with pulmonary metastases has neither been comprehensively investigated nor clarified. The aims of this retrospective study were to evaluate the value of PET/CT and identify novel prognostic indicators for pulmonary metastasectomy. Methods Between May 2004 and February 2017, 178 patients underwent PET/CT and resection of pulmonary metastases. After exclusion of patients who underwent biopsy only or duplicate cases, 142 patients were analyzed. Prognostic indicators, including PET/CT findings and outcomes were investigated. Results The median follow-up time was 42 months. The primary tumor site was colorectal in 76, kidney in 14, head and neck in 13, breast in 12, stomach in 8, urinary tract in 7, and other organs in 12 patients. The median maximal standardized uptake value (SUVmax) was 4.6. The optimal cut-off value, determined by receiver operating characteristic (ROC) analysis, identified the following cut-off values: disease-free interval (DFI) (12 months; SUVmax =4.5). Univariable analysis revealed that DFI ≤12 months, incomplete resection, and SUVmax ≥4.5 were significant for poor outcome. Multivariable analysis revealed incomplete resection and SUVmax ≥4.5 were significant for poor outcome. The 5-year survival rates of patients with SUVmax ≥4.5 and SUVmax <4.5 were 51.6% and 74.0%, respectively. Conclusions Analysis of patients undergoing pulmonary metastasectomy demonstrated that incomplete resection and an SUVmax ≥4.5 are significant prognostic indicators. PET/CT findings should be included in estimations of these patients' prognosis.
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Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Katsuyuki Suzuki
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kei Yarimizu
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kazuki Hayasaka
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
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12
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Kim W, Han I, Lee JS, Cho HS, Park JW, Kim HS. Postmetastasis survival in high-grade extremity osteosarcoma: A retrospective analysis of prognostic factors in 126 patients. J Surg Oncol 2018; 117:1223-1231. [DOI: 10.1002/jso.24963] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/27/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Wanlim Kim
- Department of Orthopaedic Surgery; Asan Medical Center; University of Ulsan College of Medicine; Songpa-gu Seoul Korea
| | - Ilkyu Han
- Department of Orthopaedic Surgery; Seoul National University Hospital; Seoul Korea
| | - Jong S. Lee
- Department of Orthopaedic Surgery; Asan Medical Center; University of Ulsan College of Medicine; Songpa-gu Seoul Korea
| | - Hwan S. Cho
- Department of Orthopaedic Surgery; Seoul National University Bundang Hospital; Gyeonggi-do Korea
| | - Jong W. Park
- Orthopaedic Oncology Clinic; National Cancer Center; Ilsandong-gu Goyang-si Gyeonggi-do Korea
| | - Han-Soo Kim
- Department of Orthopaedic Surgery; Seoul National University Hospital; Seoul Korea
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13
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Chiappetta M, Forcella D, Pierconti F, Facciolo F. Combined treatment for single giant pulmonary metastasis from osteosarcoma: from inside to outside. ANZ J Surg 2016; 88:E801-E802. [PMID: 27905188 DOI: 10.1111/ans.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/29/2016] [Accepted: 10/27/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Chiappetta
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute-IFO, Rome, Italy
| | - Daniele Forcella
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute-IFO, Rome, Italy
| | - Federico Pierconti
- Department of Anesthesia and Critical Care Medicine, Institute of Oncology, Regina Elena National Cancer Institute-IFO, Rome, Italy
| | - Francesco Facciolo
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute-IFO, Rome, Italy
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14
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Pagès PB, Le Pimpec-Barthes F, Bernard A. [Surgery for pulmonary metastases from colorectal cancer: Predictive factors for survival]. Rev Mal Respir 2016; 33:838-852. [PMID: 27133381 DOI: 10.1016/j.rmr.2016.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/11/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Colorectal cancer is the 3rd commonest cause of death from cancer: 5% of patients will develop lung metastases. The management of oligometastatic disease is based on the objective of optimal local control. STATE OF THE ART To date, no results from randomized control trials support the resection of pulmonary metastases in oligometastastic colorectal cancer patients. However, numerous series, mainly retrospective, report long-term survival for highly selected patients, with 5-year survival ranging from 45 to 65% in the most recent series. The consensual predictive factors of a good prognosis are: a disease free-interval>36 months, a number of metastases≤3, a normal level of carcino-embryonic antigen and the absence of hilar or mediastinal lymph node involvement. PERSPECTIVES Around 20 to 40% of patients will develop recurrence, probably linked to the presence of undetectable micrometastases. Therefore, experimental work is being undertaken to develop new treatment techniques such as isolated lung perfusion, radiofrequency ablation and stereotactic radiation therapy. CONCLUSION Highly selected patients suffering from colorectal cancer lung metastases could benefit from resection with improved survival and disease-control.
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Affiliation(s)
- P-B Pagès
- Service de chirurgie cardiovasculaire et thoracique, CHU Bocage central, université de Bourgogne, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Bernard
- Service de chirurgie cardiovasculaire et thoracique, CHU Bocage central, université de Bourgogne, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France
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15
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Moser M, Wiedemann D, Kitzwögerer M, Frank H. Adenocarcinoma of the ampulla of Vater metastasising into the right ventricle. BMJ Case Rep 2016; 2016:bcr-2015-212650. [PMID: 27060070 DOI: 10.1136/bcr-2015-212650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old woman, after resected adenocarcinoma of the ampulla of Vater, presented dyspnoea and beginning signs of right heart failure. Echocardiography revealed a mass within the right ventricle (RV) suspicious for a metastasis of the known adenocarcinoma. The decision for surgical resection was made by cardiovascular MR, which was able to delineate the infiltrative growth of a metastasis. An extensive resection had to be performed. Parts of the intraventricular septum as well as the tricuspid valve had to be resected. After six cycles of adjuvant systemic chemotherapy with gemcitabine and nab-paclitaxel, the patient had no macroscopic tumour recurrence. To our knowledge, this is the first report of a pancreatobiliary tumour metastasising exclusively to the RV of the heart. We conclude that in this special case aggressive surgical management following chemotherapy was very effective in controlling the disseminated adenocarcinoma of the ampulla of Vater.
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Affiliation(s)
- Magdalena Moser
- Department of Internal Medicine, University Hospital Tulln, Karl Landsteiner University, Tulln, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria
| | - Melitta Kitzwögerer
- Department of Clinical Pathology, University Hospital St Pölten, Karl Landsteiner University, St Pölten, Austria
| | - Herbert Frank
- Department of Internal Medicine, University Hospital Tulln, Karl Landsteiner University, Tulln, Austria
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16
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De Rose F, Cozzi L, Navarria P, Ascolese A, Clerici E, Infante M, Alloisio M, Testori A, Toschi L, Finocchiaro G, Santoro A, Scorsetti M. Clinical Outcome of Stereotactic Ablative Body Radiotherapy for Lung Metastatic Lesions in Non-small Cell Lung Cancer Oligometastatic Patients. Clin Oncol (R Coll Radiol) 2016; 28:13-20. [DOI: 10.1016/j.clon.2015.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/22/2015] [Accepted: 08/26/2015] [Indexed: 12/25/2022]
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17
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Xu Y, Bai L, Zhang L, Mao F, Shen-Tu Y. [Analysis of the Choice of Operation Mode and Prognosis Factors of Patients with Tumors of the Lung Metastasis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:206-11. [PMID: 25936884 PMCID: PMC6000281 DOI: 10.3779/j.issn.1009-3419.2015.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
背景与目的 肺部转移性肿瘤的治疗观念有所改变,外科手术的治疗价值及影响预后的因素值得探讨。 方法 回顾性分析2006年1月-2009年12月经手术治疗的57例肺部转移性肿瘤患者的临床资料,随访1年、3年、5年生存率,比较胸腔镜和常规开胸两种手术方式的差别,探讨患者性别、年龄、手术方式、无瘤生存间隔期(disease-free interval, DFI)、转移瘤数目、转移瘤大小及术后是否化疗与预后的关系。 结果 全组患者围手术期无死亡,患者术后1年、3年、5年生存率分别为81.3%、46.5%、29.2%,中位生存时间为33.8个月。多因素分析显示DFI、转移瘤数目和直径是影响预后的独立因素。 结论 合理选择手术治疗,能够提高肺部转移性肿瘤患者的生存期,胸腔镜是优选的手术方式,孤立性肺转移瘤及直径 < 4 cm的患者手术效果更佳。
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Affiliation(s)
- Ye Xu
- Department of Thoracic Surgery, Tongren Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200336, China
| | - Lianwei Bai
- Jilin Tumor Hospital, Changchun 130012, China
| | - Liang Zhang
- Jilin Tumor Hospital, Changchun 130012, China
| | - Feng Mao
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Yang Shen-Tu
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
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18
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Pulmonary metastasectomy: outcomes and issues according to the type of surgical resection. Gen Thorac Cardiovasc Surg 2015; 63:320-30. [PMID: 25836329 DOI: 10.1007/s11748-015-0544-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Indexed: 12/16/2022]
Abstract
According to a recent report by the Committee for Scientific Affairs of the Japanese Association for Thoracic Surgery, pulmonary metastasectomy accounted for as many as 10.2 % of all entry cases of general thoracic surgery, and its use is increasing year by year. Accordingly, many studies have examined the surgical procedures used during pulmonary metastasectomy for metastases from primary tumors affecting various organs as well as the outcomes of and indications for such procedures, but some problems remain. In this article, the following questions related to the surgical approach and the type of resection used during pulmonary metastasectomy are reviewed: (1) Wedge resection--what is a safe margin for preventing local recurrence? (2) What is the clinical significance of node sampling/dissection during pulmonary metastasectomy? and (3) When is segmentectomy necessary? In addition, we discuss: (4) open thoracotomy vs. video-assisted thoracoscopic surgery (VATS), (5) repeated metastasectomy for pulmonary metastases, (6) the surgical approach for bilateral pulmonary metastasectomy, (7) pneumonectomy, and (8) pulmonary metastasectomy combined with resection of the neighboring organs.
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19
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Moy B, Specht MC, Lanuti M, Rafferty EA, Lerwill MF. Case records of the Massachusetts General Hospital. Case 1-2015. A 66-year-old woman with metastatic breast cancer after endocrine therapy. N Engl J Med 2015; 372:162-70. [PMID: 25564900 DOI: 10.1056/nejmcpc1408601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Aged
- Anastrozole
- Androstadienes/therapeutic use
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/therapy
- Class I Phosphatidylinositol 3-Kinases
- Diagnosis, Differential
- Female
- Humans
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Lung Neoplasms/secondary
- Lymph Nodes/pathology
- Magnetic Resonance Imaging
- Mastectomy, Segmental
- Mutation
- Nitriles/therapeutic use
- Phosphatidylinositol 3-Kinases/genetics
- Receptors, Estrogen
- Receptors, Progesterone
- Risk Factors
- Triazoles/therapeutic use
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20
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Unexpected lymph node disease in resections for pulmonary metastases. Ann Thorac Surg 2014; 99:231-6. [PMID: 25440271 DOI: 10.1016/j.athoracsur.2014.08.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/18/2014] [Accepted: 08/25/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pulmonary metastasectomy is widely accepted for different malignant diseases. The role of mediastinal lymph node (LN) dissection in these procedures is discussed controversially. We evaluated our results of LN removal at the time of pulmonary metastasectomy with respect to the frequency of unexpected LN disease. METHODS This was a retrospective analysis of 313 resections performed in 209 patients. Operations were performed in curative intention. Patients with known thoracic LN involvement and those without lymphadenectomy (n = 43) were excluded. Patients were analyzed according the type of LN dissection. Subgroups of different primary cancers were evaluated separately. RESULTS Sublobar resections were performed in 256 procedures with lymphadenectomy, and 14 patients underwent lobectomy. Patients underwent radical lymphadenectomy (n = 158) or LN sampling (n = 112). The overall incidence of unexpected tumor in LN was 17% (radical lymphadenectomy, 15.8%; sampling, 18.8%). Unexpected LN involvement was found in 17 patients (35.5%) with breast cancer, in 120 (9.2%) with colorectal cancer, and in 53 (20.8%) with renal cell carcinoma. The 5-year survival was 30.2% if LN were tumor negative and 25% if positive (p = 0.19). LN sampling vs radical removal had no significant effect on 5-year survival (23.6% vs 30.9%; p = 0.29). CONCLUSIONS Dissection of mediastinal LN in resection of lung metastases will reveal unexpected LN involvement in a relevant proportion of patients, in particular in breast and renal cancer. Routine LN dissection appears necessary and may become important for further therapeutic decisions. On the basis of our data, LN sampling seems to be sufficient.
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Wang ZX, Zheng YF, Liang Y, Xu JX. Pulmonary metastases of colorectal carcinoma: Clinical characteristics, metastatic features, therapeutic methods and prognosis. Shijie Huaren Xiaohua Zazhi 2014; 22:2513-2517. [DOI: 10.11569/wcjd.v22.i17.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the clinical characteristics, metastatic features, therapeutic methods and prognosis in patients with pulmonary metastases of colorectal carcinoma.
METHODS: The clinical data of 120 patients with pulmonary metastases of colorectal cancer were retrospectively analyzed. The clinical parameters of the patients, treatment methods and the factors affecting prognosis were analyzed.
RESULTS: In patients with pulmonary metastases of colorectal carcinoma, the 6-mo, 1-, 2-, 3-, and 5-year survival rates were 78%, 44%, 26%, 19% and 16%, respectively, with an overall median overall survival (OS) period of 18.0 mo. Pulmonary symptoms, sex, age, single or multiple pulmonary metastases, the presence or absence of liver metastases, mediastinal and/or hilar lymph node involvement were not significant prognostic factors of OS (P > 0.05). Univariate analysis showed that factors significantly predicting a poor prognosis included primary tumor site (P = 0.017), vessel invasion (P = 0.024) and high T stage (P = 0.008). However, none of these were prognostic factors on multivariate analysis. There was a trend of better survival in patients submitted to metastasectomy compared with those submitted to chemotherapy alone, although there was no statistical difference (median OS: 33.0 mo vs 18.0 mo, P = 0.128). Among 153 patients who underwent radical colorectal resection, 82 had pulmonary metastases in two years after surgery, with a median disease free interval (DFI) of 20.0 mo. The factors that affected DFI included primary tumor site, morphotype, differentiation degree, T stage and N stage (P < 0.05). T stage was an independent predictive factor of DFI (P = 0.019).
CONCLUSION: T stage is an independent predictor of DFI, showing that the tumor with strong ability of invasion tend to cause lung metastasis more commonly.
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22
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Han KN, Kang CH, Park IK, Kim YT. Thoracoscopic approach to bilateral pulmonary metastasis: is it justified? Interact Cardiovasc Thorac Surg 2014; 18:615-620. [DOI: 10.1093/icvts/ivt514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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23
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Cai M, Shen-Tu Y. [Clinical diagnosis and therapy strategies of lung metastasis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:282-5. [PMID: 24667270 PMCID: PMC6019369 DOI: 10.3779/j.issn.1009-3419.2014.03.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Minghui Cai
- Department of Thoracic Surgery, Shanghai Chest Hospital/Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
| | - Yang Shen-Tu
- Department of Thoracic Surgery, Shanghai Chest Hospital/Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
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24
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KANNO RYUZO, YONECHI ATSUSHI, HIGUCHI MITSUNORI, SUZUKI HIROYUKI, OHISHI AKIO. CONCOMITANT METASTATIC LUNG TUMOR AND HAMARTOMA. Fukushima J Med Sci 2014; 60:129-32. [DOI: 10.5387/fms.2013-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- RYUZO KANNO
- Department of Thoracic Surgery, Fukushima Red Cross Hospital
| | - ATSUSHI YONECHI
- Department of Regenerative Surgery, Fukushima Medical University School of Medicine
| | | | - HIROYUKI SUZUKI
- Department of Regenerative Surgery, Fukushima Medical University School of Medicine
| | - AKIO OHISHI
- Department of Thoracic Surgery, Fukushima Red Cross Hospital
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25
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Nordholm-Carstensen A, Krarup PM, Jorgensen LN, Wille-Jørgensen PA, Harling H. Occurrence and survival of synchronous pulmonary metastases in colorectal cancer: A nationwide cohort study. Eur J Cancer 2014; 50:447-56. [DOI: 10.1016/j.ejca.2013.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/13/2013] [Accepted: 10/16/2013] [Indexed: 01/31/2023]
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26
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Thoracoscopic resection of solitary lung metastases evaluated by using thin-section chest computed tomography: is thoracoscopic surgery still a valid option? Gen Thorac Cardiovasc Surg 2013; 61:565-70. [PMID: 23832549 DOI: 10.1007/s11748-013-0284-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study evaluated long-term outcomes of pulmonary metastasectomy for solitary lung metastases to clarify the role of video-assisted thoracoscopic surgery in the selected population. METHODS We retrospectively investigated oncologic results after the resection of solitary lung metastases guided by thin-section chest computed tomography scans in 105 patients. Pulmonary metastasectomy for solitary lung metastases was approached by thoracotomy (n = 43) and by thoracoscopy (n = 62). RESULTS Compared to the thoracotomy group, the thoracoscopy group had a shorter hospital stay (p < 0.001) postoperatively. Intrathoracic recurrence developed in 11 (25.6 %) patients in the thoracotomy group and 15 (24.2 %) in the thoracoscopy group. 19 patients (18.1 %) underwent re-metastasectomy during the median 36-month (5-113) follow-up (p = 0.693). Re-metastasectomy was performed in 8 patients (18.6 %) in the thoracotomy group and in 11 patients (17.7 %) in the thoracoscopy group (p = 0.910). Overall survival was not significantly different between the two groups (p = 0.210). Intrathoracic recurrence was the only significant risk factor for overall survival (p = 0.036) in multivariate analysis. CONCLUSIONS In a highly selected group with solitary lung metastases, pulmonary metastasectomy by thoracotomy or thoracoscopy did not affect survival. There were comparable oncologic results from both surgeries when applied in solitary lung metastases from an extra-thoracic malignancy. Thoracoscopic metastasectomy is a promising option in small, solitary pulmonary metastases.
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Wohlgemut JM, Salami M, Buchan K. Bilateral pulmonary metastasectomy through right thoracotomy. Ann Thorac Surg 2013; 96:323-5. [PMID: 23816090 DOI: 10.1016/j.athoracsur.2012.11.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/07/2012] [Accepted: 11/16/2012] [Indexed: 11/27/2022]
Abstract
Bilateral thoracotomies spaced at least 4 weeks apart are often required for the resection of bilateral pulmonary metastases. The anatomic distribution of the metastatic disease may rarely permit excision of bilateral pulmonary deposits through one thoracotomy incision. We demonstrate a successful bilateral pulmonary metastasectomy in the right upper lobe, right middle lobe, and left upper lobe through a right thoracotomy in a 40-year-old man with a past history of rectal adenocarcinoma and of left open pulmonary metastasectomy 1 year previously. The left upper lobe was approached by opening the pleura anterior to the ascending aorta.
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Affiliation(s)
- Jared M Wohlgemut
- School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen, United Kingdom
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Widder J, Klinkenberg TJ, Ubbels JF, Wiegman EM, Groen HJM, Langendijk JA. Pulmonary oligometastases: metastasectomy or stereotactic ablative radiotherapy? Radiother Oncol 2013; 107:409-13. [PMID: 23773410 DOI: 10.1016/j.radonc.2013.05.024] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/15/2013] [Accepted: 05/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Stereotactic ablative radiotherapy (SABR; or stereotactic body radiotherapy, SBRT) emerges as treatment option for pulmonary oligometastatic disease (OMD), but there are no studies comparing SABR with pulmonary metastasectomy (PME). We analysed consecutive patients referred via a university-hospital based multidisciplinary team. MATERIAL AND METHODS Patients were offered PME as first choice and SABR in case they were considered to be less suitable surgical candidates. Overall survival was the primary endpoint. Secondary endpoints were progression-free-survival, local control of treated metastases, and freedom-from-failure of a local-only treatment strategy without systemic therapy. RESULTS From 2007 until 2010, 110 patients were treated and analysed (PME, n=68; SABR, n=42). Median follow-up time was 43 months (minimally, 25). Estimated overall survival rates at one, three, and five years were 87%, 62%, and 41% for PME, and 98%, 60%, and 49% for SABR, respectively (logrank-test, p=0.43). Local control at two years was 94% for SABR and 90% for PME. Progression-free survival was 17% at three years, but 43% of the patients still had not failed a local-only treatment strategy. CONCLUSIONS Although SABR was second choice after PME, survival after PME was not better than after SABR. Prospective comparative studies are clearly required to define the role of both, SABR and PME in OMD.
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Affiliation(s)
- Joachim Widder
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.
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Mitsudomi T, Suda K, Yatabe Y. Surgery for NSCLC in the era of personalized medicine. Nat Rev Clin Oncol 2013; 10:235-44. [PMID: 23438759 DOI: 10.1038/nrclinonc.2013.22] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Kidner TB, Yoon J, Faries MB, Morton DL. Preoperative imaging of pulmonary metastases in patients with melanoma: implications for minimally invasive techniques. ACTA ACUST UNITED AC 2012; 147:871-4. [PMID: 22987185 DOI: 10.1001/archsurg.2012.1667] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
HYPOTHESIS Preoperative imaging underestimates the number of pulmonary melanoma metastases. Although thoracoscopic resection is less invasive than resection via thoracotomy, it does not allow manual palpation of the lung to identify any metastases not visible on the preoperative scan or at the time of resection. DESIGN Retrospective review of a prospectively maintained database. SETTING Tertiary referral center. PATIENTS A total of 170 patients who underwent preoperative computed tomography of the chest, followed within 30 days by thoracotomy for resection of pulmonary metastatic melanoma. MAIN OUTCOME MEASURES Number of pathology-confirmed pulmonary metastases detected by preoperative chest computed tomography vs intraoperative manual palpation. RESULTS The mean age of the patients was 49.5 years at initial diagnosis of melanoma and 57.1 years at diagnosis of pulmonary metastases; 69% of patients were male. A total of 334 pulmonary metastases were resected; the mean lesion size was 2.0 cm (range, 0.1-14.0 cm). In 49 of 190 pulmonary resections (26%), manual palpation of the subpleural parenchyma revealed lesions not identified during preoperative imaging. The rate of 5-year overall survival was 33%. CONCLUSIONS Preoperative imaging underestimates the number of pulmonary lesions in patients with metastatic melanoma. Because incomplete resection of metastatic disease is associated with worse outcomes, we recommend caution when considering a minimally invasive approach for the resection of pulmonary metastatic melanoma.
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Affiliation(s)
- Travis B Kidner
- Department of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA 90404, USA
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Shiono S, Sato T, Horio H, Chida M, Matsuguma H, Ozeki Y, Nakajima J, Okumura S. Outcomes and prognostic factors of survival after pulmonary resection for metastatic gastric cancer. Eur J Cardiothorac Surg 2012; 43:e13-6. [DOI: 10.1093/ejcts/ezs574] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Toru Sato
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hirotoshi Horio
- Department of General Thoracic Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
| | | | - Yuichi Ozeki
- Department of Surgery II, National Defense Medical College, Saitama, Japan
| | - Jun Nakajima
- Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan
| | - Sakae Okumura
- Department of Chest Surgery, Cancer Institute Hospital, Tokyo, Japan
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Lung metastasectomy: Long-term outcomes in an 18-year cohort from a single center. Surg Oncol 2012; 21:237-44. [DOI: 10.1016/j.suronc.2012.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 05/12/2012] [Accepted: 05/23/2012] [Indexed: 01/15/2023]
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Abstract
Introduction. Pulmonary oligometastases are resected both for diagnostic and therapeutic reasons. The histological features may be nonspecific, resulting in diagnostic difficulties. Design. The authors retrospectively studied the clinical and pathological features of 73 open resections of lung metastases from 64 patients to determine the frequency and types of problems in establishing site of origin. Results. There were 18 primary organ sites, the most frequent being colon (n = 10), head and neck (9 squamous and 6 salivary gland), kidney (n = 7), and soft tissue (n = 7). Unusual histological features included detached alveolar tumor clusters at the periphery (83% of adenocarcinomas), lepidic spread (2 metastatic pancreatic tumors), and entrapped pneumocyte-lined cysts (6 tumors). A majority of squamous carcinomas from the head and neck presented difficulties in regard to excluding a second primary, especially 4 with basaloid features that mimicked primary basaloid lung carcinoma. Other tumors mimicking lung primaries included pancreatic, endometrial, and breast metastases. Germ-cell tumors, sarcomas, melanomas, and sarcomatoid carcinomas presented diagnostic difficulties. Overall, comparison with the primary tumor with or without immunohistochemical studies was performed in 38 of 73 cases (52%). Conclusions. Pulmonary oligometastases comprise a wide range of histological types and often require careful pathological evaluation to determine primary site of origin.
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Affiliation(s)
- Lauren Xu
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Allen P. Burke
- University of Maryland Medical Center, Baltimore, MD, USA
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Zhang H, Chen X, Wang H, Zhang L, Zhou W, Zhao M. [The diagnosis and surgical treatment for solitary pulmonary metastases: a report of 156 cases]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2012; 15:223-7. [PMID: 22510508 PMCID: PMC5999975 DOI: 10.3779/j.issn.1009-3419.2012.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
背景与目的 近年来手术治疗孤立性肺转移瘤取得了满意的疗效,为提高患者的生存率,本研究对其诊断、外科治疗的适应证、手术方式及影响预后的因素进行分析讨论。 方法 对156例接受手术治疗的孤立性肺转移瘤患者的临床资料进行回顾性分析。 结果 原发肿瘤为癌者134例,肉瘤21例,不明组织类型1例。全组无围手术期死亡,随访153例,随访时间1年-10年。术后5生存率为31.2%,中位生存期为35.8个月。113例行淋巴结系统性清扫,淋巴结转移阴性和阳性患者5年生存率分别为37.3%、12.5%。行肺叶切除术患者5年生存率为38.5%。 结论 手术治疗孤立性肺转移瘤可取得满意的疗效,电视胸腔镜手术是有效的手术方式,有无淋巴结转移和肺叶切除方式是影响预后的重要因素。
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Affiliation(s)
- Hui Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai 200433, China.
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