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Ambrogi MC, Aprile V, Sanna S, Forti Parri SN, Rizzardi G, Fanucchi O, Valentini L, Italiani A, Morganti R, Cartia CF, Hughes JM, Lucchi M, Droghetti A. Lung Metastasectomy: Where Do We Stand? Results from an Italian Multicentric Prospective Database. J Clin Med 2024; 13:3106. [PMID: 38892816 PMCID: PMC11172471 DOI: 10.3390/jcm13113106] [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: 04/08/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: The surgical resection of pulmonary metastases is considered a therapeutic option in selected cases. In light of this, we present the results from a national multicenter prospective registry of lung metastasectomy. Methods: This retrospective analysis involves data collected prospectively and consecutively in a national multicentric Italian database, including patients who underwent lung metastasectomy. The primary endpoints were the analysis of morbidity and overall survival (OS), with secondary endpoints focusing on the analysis of potential risk factors affecting both morbidity and OS. Results: A total 470 lung procedures were performed (4 pneumonectomies, 46 lobectomies/bilobectomies, 13 segmentectomies and 407 wedge resections) on 461 patients (258 men and 203 women, mean age of 63.1 years). The majority of patients had metastases from colorectal cancer (45.8%). In most cases (63.6%), patients had only one lung metastasis. A minimally invasive approach was chosen in 143 cases (30.4%). The mean operative time was 118 min, with no reported deaths. Morbidity most frequently consisted of prolonged air leaking and bleeding, but no re-intervention was required. Statistical analysis revealed that morbidity was significantly affected by operative time and pulmonary comorbidities, while OS was significantly affected by disease-free interval (DFI) > 24 months (p = 0.005), epithelial histology (p = 0.001) and colorectal histology (p = 0.004) during univariate analysis. No significant correlation was found between OS and age, gender, surgical approach, surgical extent, surgical device, the number of resected metastases, lesion diameter, the site of lesions and nodal involvement. Multivariate analysis of OS confirmed that only epithelial histology and DFI were risk-factors, with p-values of 0.041 and 0.031, respectively. Conclusions: Lung metastasectomy appears to be a safe procedure, with acceptable morbidity, even with a minimally invasive approach. However, it remains a local treatment of a systemic disease. Therefore, careful attention should be paid to selecting patients who could truly benefit from surgical intervention.
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Affiliation(s)
- Marcello Carlo Ambrogi
- Department for Surgical, Medical, Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy
- Division of Thoracic Surgery, University Hospital of Pisa, 56124 Pisa, Italy
| | - Vittorio Aprile
- Department for Surgical, Medical, Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy
- Division of Thoracic Surgery, University Hospital of Pisa, 56124 Pisa, Italy
| | - Stefano Sanna
- Multispecialistic Surgical Department, Private Forlì Hospitals, 47122 Forlì, Italy
| | | | - Giovanna Rizzardi
- Division of Thoracic Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, University Hospital of Pisa, 56124 Pisa, Italy
| | - Leonardo Valentini
- Department of Thoracic Surgery, IRCCS University Hospital of Bologna, 40138 Bologna, Italy
| | - Alberto Italiani
- Division of Thoracic Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy
| | - Riccardo Morganti
- Statistical Support Division for Clinical Studies, University Hospital of Pisa, 56124 Pisa, Italy
| | | | - James M. Hughes
- Division of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
| | - Marco Lucchi
- Department for Surgical, Medical, Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy
- Division of Thoracic Surgery, University Hospital of Pisa, 56124 Pisa, Italy
| | - Andrea Droghetti
- Division of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
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Casiraghi M, Spaggiari L. 22-Year Disease-Free Survival After Extended Pulmonary Metastasectomy: The Evidence of Success. Ann Thorac Surg 2020; 111:2091. [PMID: 33189666 DOI: 10.1016/j.athoracsur.2020.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Monica Casiraghi
- Department of Thoracic Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy.
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Brand L, Figueroa PU. Commentary: 3D-imaging and surgical precision: How small can the anatomic resection be? JTCVS Tech 2020; 4:314-315. [PMID: 34318058 PMCID: PMC8307457 DOI: 10.1016/j.xjtc.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/16/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Leonardo Brand
- Division of Thoracic Surgery, Hospital Julia Kubitschek, Belo Horizonte, Minas Gerais, Brazil
| | - Paula Ugalde Figueroa
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Pneumologie et Cardiologie de Quebec, Quebec City, Quebec, Canada
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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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Gelzinis TA. The Society of Thoracic Surgeons Consensus Statements for the Surgical Treatment of Pulmonary Metastases. J Cardiothorac Vasc Anesth 2019; 33:2448-2452. [PMID: 31060938 DOI: 10.1053/j.jvca.2019.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/11/2022]
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Petrella F, Spaggiari L. Comparison of pulmonary metastasectomy and stereotactic body radiation therapy for the treatment of lung metastases. J Thorac Dis 2019; 11:S280-S282. [PMID: 30997197 DOI: 10.21037/jtd.2019.01.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Abstract
For decades, surgical resection of pulmonary metastases has been performed; despite limited randomized data, surgery is increasingly accepted as an integral part in the management of metastatic disease. Long-term results indicate resection is potentially curative with significantly improved survival following complete resection. Recurrence, however, is not uncommon with many patients undergoing repeat resection. With advancing surgical technique and adjuvant therapies, patients with high or recurrent tumor burden are increasingly afforded disease control and potential cure. In this review, the prognostic characteristics of pulmonary metastases from sarcoma, preoperative evaluation, operative technique, long-term outcomes, and management of complex patients are highlighted.
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Affiliation(s)
- Christopher S Digesu
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA 02155, USA
| | - Ory Wiesel
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA 02155, USA
| | - Ara A Vaporciyan
- Division of Surgery, Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 1489, Houston, TX 77030, USA
| | - Yolonda L Colson
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA 02155, USA.
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Abstract
Metastasectomy is the most frequent surgical resection undertaken by thoracic surgeons, being the lung the second common site of metastases. The present oncological criteria for pulmonary metastasectomy are: (I) the primary cancer need to be controlled or controllable; (II) no extrathoracic metastasis-that is not controlled or controllable-exists; (III) all of the tumor must be resectable, with adequate pulmonary reserve; (IV) there are no alternative medical treatment options with lower morbidity. General favourable prognostic features in patients with pulmonary metastases are: (I) one or few metastases; (II) long disease free interval; (III) normal CEA levels in colorectal cancers. Negative predictive features in patients candidate to pulmonary metastasectomies are: (I) active primary cancer; (II) extrathoracic metastases; (III) inability to obtain surgical radicality; (IV) mediastinal lymphatic spread. The lack of controlled trials and studies limited by short follow-up and small cohorts did not allow to overcome some skepticism; moreover, the heterogeneity of these patients in terms of demographic, biologic and histologic characteristics represents a clear limit even in the largest series. On the basis of present knowledge, without results coming from on-going randomized trials, radical resection, histology, and disease free interval seem to be independent prognostic factors identifying a cohort of patients maximally benefitting from lung metastasectomy.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Cristina Diotti
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Arianna Rimessi
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Pagès PB, Serayssol C, Brioude G, Falcoz PE, Brouchet L, Le Pimpec-Barthes F, Thomas PA, Bernard A. Risk factors for survival and recurrence after lung metastasectomy. J Surg Res 2016; 203:293-300. [DOI: 10.1016/j.jss.2016.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 12/27/2022]
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Petrella F, Spaggiari L. Therapeutic options following pneumonectomy in non-small cell lung cancer. Expert Rev Respir Med 2016; 10:919-25. [PMID: 27176616 DOI: 10.1080/17476348.2016.1188694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pneumonectomy can be considered the most appropriate treatment for lung cancer that cannot be removed by lesser resection on. AREAS COVERED Therapeutic options following pneumonectomy may be required at least in 3 different scenarios: 1) an early approach due to acute surgical complications 2) a late approach due to chronic surgical complications 3) an integrated radio-chemotherapeutic adjuvant approach for advanced stages. In this review we focused on these three settings with particular emphasis to surgical approach as well as to alternative options. Expert commentary: Pneumonectomy itself does not preclude postoperative additional treatments, if needed, to maximize oncological results and to manage potential short or long term complications. However, as pneumonectomy puts a significant physiological stress on the respiratory and circulatory systems, the benefits and risks of pneumonectomy should be compared with those of alternative, non-resectional treatment modalities.
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Affiliation(s)
| | - Lorenzo Spaggiari
- a Department of Thoracic Surgery , University of Milan , Milan , Italy.,b Department of Oncology and Hematology/Oncology - DIPO , University of Milan , Milan , Italy
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Mineo TC, Ambrogi V. Lung metastasectomy: an experience-based therapeutic option. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:194. [PMID: 26417578 DOI: 10.3978/j.issn.2305-5839.2015.08.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Tommaso Claudio Mineo
- Thoracic Surgery Department, Tor Vergata University, Tor Vergata Policlinico, viale Oxford 81, 00133 Rome, Italy
| | - Vincenzo Ambrogi
- Thoracic Surgery Department, Tor Vergata University, Tor Vergata Policlinico, viale Oxford 81, 00133 Rome, Italy
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