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Ceylan KC, Batıhan G, Kaya SO. Pulmonary metastases in urogenital cancers: Surgical treatment and outcomes. Cir Esp 2023; 101:116-122. [PMID: 36774001 DOI: 10.1016/j.cireng.2021.11.025] [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: 10/01/2021] [Accepted: 11/26/2021] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Metastasis is remaining one of the major problems in cancer treatment. Like many other malignancies, urogenital tumors originating from kidney, prostate, testes, and bladder tend to metastasize to the lungs. The aim of this retrospective study is to evaluate the operative results and prognosis of pulmonary metastasectomy in patients with primary urogenital tumors. METHODS This study was approved by the local ethical committee. We retrospectively analyzed the surgical and oncological results of patients who underwent lung resections for urogenital cancer metastases in our department between 2002 and 2018. Demographic data and clinicopathological features were extracted from the medical records. Survival outcomes according to cancer subtypes and early postoperative results of VATS and thoracotomy were analyzed. RESULTS 22 out of 126 patients referred for pulmonary metastasectomy to our department had metastases from urogenital tumors. These patients consisted of 17 males and five females. Their metastasis originated from renal cell carcinoma (RCC; n=9), bladder tumor (n=7), testis tumors (n=4), and prostate cancer (n=2). There was no intraoperative complication. Postoperative complications were seen in 2 patients. CONCLUSIONS Although pulmonary metastasectomy in various types of tumors is well known and documented, the data is limited for metastases of urogenital cancers in the literature. Despite the limitations of this study, we aim to document our promising results of pulmonary metastasectomy in patients with primary urogenital tumors and wanted to emphasize the role of minimally invasive approaches.
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Affiliation(s)
- Kenan Can Ceylan
- Department of Thoracic Surgery, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Turkey
| | - Guntug Batıhan
- Department of Thoracic Surgery, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Turkey.
| | - Seyda Ors Kaya
- Department of Thoracic Surgery, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Turkey
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Ceylan KC, Batıhan G, Kaya SO. Pulmonary metastases in urogenital cancers: Surgical treatment and outcomes. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pathologic concordance of resected metastatic nonseminomatous germ cell tumors in the chest. J Thorac Cardiovasc Surg 2020; 161:856-868.e1. [PMID: 33478834 DOI: 10.1016/j.jtcvs.2020.10.158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Men with metastatic nonseminomatous germ cell tumors (NSGCTs) often present with residual chest tumors after chemotherapy. We examined the pathologic concordance of intrathoracic disease and outcomes based on the worst pathology of disease resected at first thoracic surgery. METHODS A retrospective analysis was performed of consecutive patients undergoing thoracic resection for metastatic NSGCT in our institution between 2005 and 2018. RESULTS Eighty-nine patients (all men) were included. The median age was 29 years (interquartile range [IQR], 23-35 years). Primary sites were testis (n = 84; 94.4%) and retroperitoneum (n = 5; 5.6%). Eighty-seven patients received chemotherapy before undergoing surgery. Nineteen patients (21.3%; group 1) had malignancy resected at first surgery (OR1), and the other 70 patients had benign disease at OR1 (78.7%; group 2). Concordant pathology between lungs was 85.2% in group 1 and 91% in group 2, and between lung and mediastinum was 50% in group 1 and 72.7% in group 2. Despite no teratoma at OR1, 3 patients (15.8%) in group 2 had resection of teratoma (n = 2) or malignancy (n = 1) at future surgery. After a mean follow-up of 65.5 months (IQR, 23.1-89.2 months) for group 1 and 47.7 months (IQR, 13.0-75.1 months) for group 2, overall survival was significantly worse for group 1 (68.4% vs 92.9%; P = .03). CONCLUSIONS The wide range of pathology resected in patients with intrathoracic NSGCT metastases requires careful decision making regarding treatment. Pathologic concordance between lungs is better than that between lung and mediastinum in patients with intrathoracic NSGCT metastases. Aggressive surgical management should be considered for all residual disease due to the low concordance between sites and the potential for excellent long-term survival even in patients with chemotherapy-refractory disease.
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Abstract
Germ cell tumors (GCTs) are the most common malignancy among young men in the United States. Although prognosis is favorable and response to cisplatin-based chemotherapy regimens is good, 10%–20% of patients with thoracic metastases require surgical management following completion of chemotherapy. Pulmonary metastasectomy (PM) has been employed for GCT patients with lung metastases for several decades. Outcomes have been excellent thus far. However, there have been no randomized controlled trials of PM in GCT and, as new surgical techniques are developed, there is variability in management. This article reviews the existing data on current management of pulmonary metastases in GCT, with attention paid to timing of surgery, surgical approaches, and complications.
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Affiliation(s)
- Armin Farazdaghi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David J Vaughn
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunil Singhal
- Divison of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Cheung FPY, Alam NZ, Wright GM. The Past, Present and Future of Pulmonary Metastasectomy: A Review Article. Ann Thorac Cardiovasc Surg 2019; 25:129-141. [PMID: 30971647 PMCID: PMC6587129 DOI: 10.5761/atcs.ra.18-00229] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary metastases are a sign of advanced malignancy and an omen of poor prognosis. Once primary tumors metastasize, they become notoriously difficult to treat and interdisciplinary management often involves a combination of chemotherapy, radiotherapy, and surgery. Over the last 25 years, the emerging body of evidence has recognized the curative potential of pulmonary metastasectomy. Surgical resection of pulmonary metastases is now commonly considered for patients with controlled primary disease, absence of widely disseminated extrapulmonary disease, completely resectable lung metastases, sufficient cardiopulmonary reserve, and lack of a better alternative systemic therapy. Since the development of these selection criteria, other prognostic factors have been proposed to better predict survival and optimize the selection of surgical candidates. Disease-free interval (DFI), completeness of resection, surgical approach, number and laterality of lung metastases, and lymph node metastases all play a dynamic role in determining patient outcomes. There is a definite need to continue reviewing these prognosticators to identify patients who will benefit most from pulmonary metastasectomy and those who should avoid unnecessary loss of lung parenchyma. This literature review aims to explore and synthesize the last 25 years of evidence on the long-term survival, prognostic factors, and patient selection process for pulmonary metastasectomy.
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Affiliation(s)
| | - Naveed Zeb Alam
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Gavin Michael Wright
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
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Schweiger T, Lang G, Klepetko W, Hoetzenecker K. Prognostic factors in pulmonary metastasectomy: spotlight on molecular and radiological markers. Eur J Cardiothorac Surg 2014; 45:408-416. [DOI: 10.1093/ejcts/ezt288] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Treasure T, Milošević M, Fiorentino F, Macbeth F. Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness? Thorax 2014; 69:946-9. [PMID: 24415715 PMCID: PMC4174129 DOI: 10.1136/thoraxjnl-2013-204528] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pulmonary metastasectomy is a commonly performed operation and is tending to increase as part of a concept of personalised treatment for advanced cancer. There have been no randomised trials; belief in effectiveness of metastasectomy is based on registry data and surgical follow-up studies. These retrospective series are comprised predominately of solitary or few metastases with primary resection to metastasectomy intervals longer than 2-3 years. Five-year survival rates of 30-50% are recorded, but as case selection is based on favourable prognostic features, an apparent association between metastasectomy and survival cannot be interpreted as causation. Cancers for which lung metastasectomy is used are considered in four pathological groups. In non-seminomatous germ cell tumour, for which chemotherapy is highly effective, excision of residual pulmonary disease guides future treatment and in particular allows an informed decisions as to further chemotherapy. Sarcoma metastasises predominately to lung and pulmonary metastasectomy for both bone and soft tissues sarcoma is routinely considered as a treatment option but without randomised data. The commonest circumstance for lung and liver metastasectomy is colorectal cancer. Repeated resections and ablations are commonplace but without evidence of effectiveness for either. For melanoma, results are particularly poor, but lung metastases are resected when no other treatment options are available. In this review, the available evidence is considered and the conclusion reached is that in the absence of randomised trials there is uncertainty about effectiveness. A randomised controlled trial, Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), is in progress and randomised trials in sarcoma seem warranted.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Mišel Milošević
- Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Francesca Fiorentino
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, UK
| | - Fergus Macbeth
- Wales Cancer Trials Unit, Cardiff University, Cardiff, UK
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Ripley RT, Downey RJ. Pulmonary metastasectomy. J Surg Oncol 2013; 109:42-6. [PMID: 24301202 DOI: 10.1002/jso.23450] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 09/10/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Robert T Ripley
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Pfannschmidt J, Egerer G, Bischof M, Thomas M, Dienemann H. Surgical intervention for pulmonary metastases. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:645-51. [PMID: 23094000 DOI: 10.3238/arztebl.2012.0645] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 03/28/2012] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Autopsy studies of persons who died of cancer have shown the lungs to be the sole site of metastasis in about 20% of cases. The resection of pulmonary metastases is indicated for palliative purposes if they contain a large volume of necrotic tumor, infiltrate the thoracic wall to produce pain, or cause hemoptysis or retention pneumonia. Metastasectomy with curative intent may be indicated for carefully selected patients. METHODS This review is based on a selective search of the PubMed database for articles that were published from 2006 to 2011 and contained the keywords "pulmonary metastasectomy," "lung resection of metastasis," and "lung metastasectomy." RESULTS No prospective comparative trials have been performed to date that might provide evidence for prolongation of survival by pulmonary metastasectomy; nor have there been any randiomized, controlled trials yielding evidence that would assist in the decision whether to treat pulmonary metastases with surgery, radiotherapy, or chemotherapy (or some combination of these). The indication for surgery is a function of the histology of the primary tumor, the number and location of metastases, the lung capacity that is expected to remain after surgery, and the opportunity for an R0 resection. Favorable prognostic factors include a long disease-free interval between the treatment of the primary tumor and the discovery of pulmonary metastases, the absence of thoracic lymph node metastases, and a small number of pulmonary metastases. The reported 5-year survival rates after pulmonary metastasectomy, depending on the primary tumor, are 35.5% to 47% for renal-cell carcinoma, 39.1% to 67.8% for colorectal cancer, 29% to 52% for soft-tissue sarcoma, 38% to 49.7% for osteosarcoma, and 79% to 94% for non-seminomatous germ-cell tumors. For the latter two types of tumor, chemotherapy is the most beneficial form of treatment for long-term survival. CONCLUSION When there is no good clinical alternative, the resection of pulmonary metastases can give some patients long-lasting freedom from malignant disease. Patients should be carefully selected on the basis of clinical staging with defined prognostic indicators.
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Affiliation(s)
- Joachim Pfannschmidt
- Department of Thoracic Surgery at the Thoraxklinik, Heidelberg University Hospital, Germany.
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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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Cho JW, Park KS. Pulmonary Metastasectomy from Testicular Germ Cell Tumor -A case report-. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jun-woo Cho
- Department of Thoracic and Cardiovascular Surgery, Daegu Catholic Medical Center
| | - Ki Sung Park
- Department of Thoracic and Cardiovascular Surgery, Daegu Catholic Medical Center
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Hornbech K, Ravn J, Steinbrüchel DA. Current status of pulmonary metastasectomy. Eur J Cardiothorac Surg 2010; 39:955-62. [PMID: 21115259 DOI: 10.1016/j.ejcts.2010.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 09/24/2010] [Accepted: 10/06/2010] [Indexed: 11/25/2022] Open
Abstract
Malignant disease's ability to metastasize remains one of the major obstacles when treating patients with cancer. The change from loco-regional to systemic disease usually renders the patient beyond surgical treatment, as local treatment with surgery in a systemic disease is usually considered without benefit. However, numerous retrospective studies have demonstrated that resection of metastases limited to the lungs may be associated with prolonged survival. No prospective, randomized studies have been published, and most series compare highly selected patients with historical data for unresected patients. In this article, we discuss the current status on pulmonary metastasectomy. Preoperative assessment and selection of surgical candidates is covered. The different surgical strategies including surgical approach, unilateral versus bilateral exploration, lymph node dissection, and repeat surgery are discussed. Finally, we review some of the common tumors that metastasize to the lungs, the role of metastasectomy in their treatment and the prognostic factors with impact on survival.
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Affiliation(s)
- Kåre Hornbech
- Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
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Abstract
Pulmonary metastases are common in patients after resection for nonseminomatous germ cell tumor of the testis. There is solid evidence that resection for residual pulmonary disease, after adjuvant chemotherapy, can provide patients with a long-term survival. This article addresses the issues of patient selection and prognostic factors with the current review of pulmonary metastasectomy in metastatic nonseminomatous germ cell tumors retrieved from retrospective studies. In summary, there is a substantial body of evidence demonstrating that resection of residual lesions after chemotherapy can be performed safely with a low mortality rate. For a subset of patients with viable malignant tumor cells after chemotherapy, the overall results of a 5-year actuarial survival rate ranged between 42 and 61%. However, no presurgical algorithm had proven effective at predicting histologic outcome and, similar to that in pulmonary metastasectomy in general, no prospective randomized trials have been conducted to define the role of surgery versus a nonsurgical treatment regimen.
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Abstract
Pediatric pulmonary tumors are rare. There is often a significant delay in diagnosis of pulmonary tumors secondary to their rarity and nonspecific presenting physiologic and radiographic findings. A high index of suspicion in pediatric patients with recurrent or persistent pulmonary symptoms is of paramount importance in diagnosing pulmonary tumors at an early stage. Malignant pulmonary tumors are more frequently diagnosed than benign lesions, with metastatic cancers being the most common. Complete surgical resection remains the basis of therapy for primary lesions, and its role in secondary cancers is becoming more established. Adjuvant therapies are frequently employed depending on the precise tumor involved. Mortality rates vary greatly depending on tumor location, stage, and type.
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Affiliation(s)
- Christopher B Weldon
- Department of Pediatric Surgery, Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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