Abstract
Background
The level of evidence for efficacy of local treatment of pulmonary metastases is low; therefore, complication rates should be minimized. Minimally invasive techniques may have the potential to reduce morbidity but potentially lead to more local and/or ipsilateral recurrences. The objective of this study was to evaluate the introduction of a new treatment strategy incorporating the increased use of video-assisted thoracic surgery (VATS) and radiofrequency ablation (RFA), weighing complications against recurrence rates.
Methods
We retrospectively reviewed results of all local treatment of pulmonary metastases in the Netherlands Cancer Institute from 2002 to 2007. Each of 158 identified interventions was analyzed separately to retrieve procedure-related data. Overall survival data were analyzed per patient. To evaluate the introduction of a strategy incorporating minimally invasive techniques, the study period was split in two (before and after the introduction of this strategy in July 2004).
Results
In Strategy I, 47 interventions (2 VATS, no RFA) were performed in 37 patients; in Strategy II 111 interventions (51 VATS and RFA) in 86 patients. Metastases of a variety of primary tumors were treated. Median hospital stay was shorter (5 vs. 7 days) and procedure-related morbidity was less with Strategy II (p < 0.01). Time-to-recurrence rates were comparable (p = 0.18), as were local and ipsilateral recurrence rates within 3 years (p = 0.72). Estimated overall 3-year survival was 59% for patients treated with Strategy I and 54% with Strategy II.
Conclusions
Increased use of minimally invasive techniques for local treatment of pulmonary metastatic disease is associated with low morbidity, without apparent reduction in (local) disease control.
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References
The International Registry of Lung Metastases (1997) Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 113:37–49
Neuman HB, Patel A, Hanlon C, Wolchok JD, Houghton AN, Coit DG (2007) Stage IV melanoma and pulmonary metastases: factors predictive of survival. Ann Surg Oncol 14:2847–2853
Pfannschmidt J, Dienemann H, Hoffmann H (2007) Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. Ann Thorac Surg 84:324–338
Warwick R, Page R (2007) Resection of pulmonary metastases from colorectal carcinoma. Eur J Surg Oncol 33(Suppl 2):S59–S63
van Geel AN, Pastorino U, Jauch KW, Judson IR, van Coevorden F, Buesa JM, Nielsen OS, Boudinet A, Tursz T, Schmitz PI (1996) Surgical treatment of lung metastases: the European Organization for research and treatment of cancer-soft tissue and bone sarcoma group study of 255 patients. Cancer 77:675–682
Welter S, Jacobs J, Krbek T, Krebs B, Stamatis G (2007) Long-term survival after repeated resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg 84:203–210
Cerfolio RJ, McCarty T, Bryant AS (2009) Non-imaged pulmonary nodules discovered during thoracotomy for metastasectomy by lung palpation. Eur J Cardiothorac Surg 35:786–791
Parsons AM, Ennis EK, Yankaskas BC, Parker LA, Hyslop WB, Detterbeck FC (2007) Helical computed tomography inaccuracy in the detection of pulmonary metastases: can it be improved? Ann Thorac Surg 84:1830–1836
Pastorino U, Grunenwald D (2008) Surgical resection of pulmonary metastases. In: Patterson GA, Cooper JD, Deslauriers J (eds) Pearson’s thoracic and esophageal surgery. Churchill Livingstone Elsevier, Philadelphia, pp 851–854
Rubin P, Brasacchio R, Katz A (2006) Solitary metastases: illusion versus reality. Semin Radiat Oncol 16:120–130
McCormack PM, Bains MS, Begg CB, Burt ME, Downey RJ, Panicek DM, Rusch VW, Zakowski M, Ginsberg RJ (1996) Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial. Ann Thorac Surg 62:213–216
van der Veen AH, van Geel AN, Hop WC, Wiggers T (1998) Median sternotomy: the preferred incision for resection of lung metastases. Eur J Surg 164:507–512
Nakas A, Klimatsidas MN, Entwisle J, Martin-Uncar AE, Waller DA (2009) Video-assisted versus open pulmonary metastasectomy: the surgeon’s finger or the radiologist’s eye? Eur J Cardiothorac Surg 36:469–474
Roth JA, Pass HI, Wesley MN, White D, Putnam JB, Seipp C (1986) Comparison of median sternotomy and thoracotomy for resection of pulmonary metastases in patients with adult soft-tissue sarcomas. Ann Thorac Surg 42:134–138
Kang MC, Kang CH, Lee HJ, Goo JM, Kim YT, Kim JH (2008) Accuracy of 16-channel multi-detector row chest computed tomography with thin sections in the detection of metastatic pulmonary nodules. Eur J Cardiothorac Surg 33:473–479
Fernando HC (2008) Radiofrequency ablation to treat non-small cell lung cancer and pulmonary metastases. Ann Thorac Surg 85:S780–S784
Loehe F, Kobinger S, Hatz RA, Helmberger T, Loehrs U, Fuerst H (2001) Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy. Ann Thorac Surg 72:225–229
Matsuzaki Y, Shimizu T, Edagawa M, Hara M, Tomita M, Ayabe T, Onitsuka T (2003) “The Law of 3”: prognostic parameters for resected metastatic pulmonary tumors. Ann Thorac Cardiovasc Surg 9:290–294
Pfannschmidt J, Klode J, Muley T, Dienemann H, Hoffmann H (2006) Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients. Ann Thorac Surg 81:448–454
Sano Y, Kanazawa S, Mimura H, Gobara H, Hiraki T, Fujiwara H, Yamane M, Toyooka S, Oto T, Date H (2008) A novel strategy for treatment of metastatic pulmonary tumors: radiofrequency ablation in conjunction with surgery. J Thorac Oncol 3:283–288
Lencioni R, Crocetti L, Cioni R, Suh R, Glenn D, Regge D, Helmberger T, Gillams A, Frilling A, Ambrogi M, Bartolozzi C, Mussi A (2008) Response to radiofrequency ablation of pulmonary tumors: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study). Lancet Oncol 9:621–628
Rusch VW (2010) Pulmonary metastasectomy: a moving target. J Thorac Oncol 5:S130–S131
Disclosure
Drs. Von Meyenfeldt, Wouters, Lai A Fat, Prevoo, Burgers, van Sandick, and Klomp have no conflicts of interest or financial ties to disclose.
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von Meyenfeldt, E.M., Wouters, M.W., Fat, N.L.A. et al. Local treatment of pulmonary metastases: from open resection to minimally invasive approach? Less morbidity, comparable local control. Surg Endosc 26, 2312–2321 (2012). https://doi.org/10.1007/s00464-012-2181-z
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DOI: https://doi.org/10.1007/s00464-012-2181-z