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Surgical Treatment of Lung Cancer. Onugha Osita I,Lee Jay M Cancer treatment and research In this chapter, we discuss the preoperative evaluation that is necessary prior to surgical resection, stage-specific surgical management of lung cancer, and the procedural steps as well as the indications to a variety of surgical approaches to lung resection. 10.1007/978-3-319-40389-2_4
Surgical management of lung metastases. Patrini Davide,Panagiotopoulos Nikolaos,Lawrence David,Scarci Marco British journal of hospital medicine (London, England : 2005) Management of pulmonary metastases has evolved considerably over the last few decades but is still controversial. The surgical management of lung metastases is outlined, discussing the preoperative management, indications for surgery, the surgical approach and outcomes according to the primary histology. 10.12968/hmed.2017.78.4.192
Pulmonary metastasectomy: an overview. Petrella Francesco,Diotti Cristina,Rimessi Arianna,Spaggiari Lorenzo Journal of thoracic disease 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. 10.21037/jtd.2017.03.175
Surgical treatment of pulmonary metastasis: report from a tertiary care center. Saleh Waleed,AlShammari Abdullah,Sarraj Jumana,AlAshgar Omniyah,Ahmed Mohamed Hussein,AlKattan Khaled Asian cardiovascular & thoracic annals Objective This retrospective analysis aimed to determine the factors influencing prognosis in adult patients who presented to our thoracic surgery service with lung metastases and were eligible for pulmonary metastasectomy. Methods We retrospectively reviewed the data of 296 patients who underwent resection of 575 lung metastases from January 2000 to January 2016. Univariate and multivariate analyses were performed based on age, sex, histology of the primary tumor, disease-free interval, number and size of metastases. Results Sixty-eight (22.97%) patients developed lung metastases from bone sarcoma, 68 (22.97%) from soft-tissue sarcoma, 56 (18.9%) from head and neck cancers, 46 (15.5%) from colorectal cancer, and 58 (19.6%) from other epithelial tumors. The mean size of the lung nodules was 2.48 cm. Open surgical resection was performed in 217 (73.3%) patients. After a mean follow-up of 43 months, 120 (40.7%) patients had died or were lost to follow-up. Univariate analysis confirmed that patients with bone cancer, soft tissue sarcoma, or colorectal carcinoma had a worse prognosis ( p = 0.0003). Moreover, those with a disease-free interval >24 months had a better 5-year survival ( p = 0.0001). The number and size of metastases, age, and sex had no effect on prognosis. The actuarial survival after complete metastasectomy was 71.6% (95% confidence interval: 66-75) at 2 years and 59.3% (95% confidence interval: 56-64) at 5 years. Conclusions Pulmonary metastasectomy provides good long-term survival. The type of primary tumor and disease-free interval are independent prognostic factors for survival. 10.1177/0218492318767795
[Is surgical treatment of pulmonary metastases justified?] Detillon D E M A,van Eijck Casper H J,Veen Eelco J Nederlands tijdschrift voor geneeskunde Until recently, patients with cancer and distant metastases were considered incurable. However, nowadays, some of these patients are eligible for curative-intent therapy. Surgery of metastases is becoming an increasingly important part of this ever-evolving therapy. The introduction of minimally invasive surgical techniques has resulted in more resections being performed of pulmonary metastases, even in elderly patients. Low postoperative morbidity and mortality rates have been observed after pulmonary metastasectomy. This is also true for elderly patients as age has not been linked to postoperative morbidity. Long-term survival is better for patients undergoing pulmonary metastasectomy compared to non-surgically treated patients. However, selection bias plays an important role as only relatively fit patients can tolerate surgery and their prognosis is therefore better from the onset. The question therefore remains whether pulmonary metastasectomy, a non-evidence-based treatment, is justified.
[Pulmonary metastasectomy]. Dackam Sandrine,Ojanguren Amaia,Perentes Jean Yannis,Abdelnour-Berchtold Etienne,Krueger Thorsten,Karenovics Wolfram,Triponez Frédéric,Gonzalez Michel Revue medicale suisse The lung is the second site of metastasis after the liver, affecting 30 to 40 % of all patients with a malignant tumor. Chemotherapy seems to be ineffective for some types of tumor. Although there are no prospective randomized studies that confirm the benefit of surgical pulmonary metastasectomy, many studies have shown the existence of a group of patients with pulmonary metastases who benefit from a complete resection for curative purposes in case of complete resection of lung metastases. Different approaches are known to achieve a complete resection with maximum lung parenchyma sparing. Minimal invasive approaches appear to offer a better quality of life and have equivalent oncologic outcomes compared to the open approach.
The myth of pulmonary metastasectomy. British journal of cancer Pulmonary metastasectomy is widely and increasingly practiced in the belief that this intervention can cure patients with colorectal cancer, and that without it few survive 5 years. No good evidence exists supporting such convictions, indeed recent trial results challenge them. What evidence underpins this acceptance of illusory truths or misconceptions? 10.1038/s41416-020-0927-2
[Pulmonary metastasectomy: indication and technique]. Osei-Agyemang T,Ploenes T,Passlick B Zentralblatt fur Chirurgie Distant metastases of solid tumours are most frequently located in the lung. Most patients with lung metastases suffer from multiple pulmonary lesions or metastases in other organs, which makes these patients unsuitable for surgical treatment. However, several studies suggest a survival benefit if complete resection of all pulmonary metastases is possible. In some patients pulmonary metastasectomy may even be the only curative treatment option. If pulmonary metastases are suspected contrast-enhanced computed tomography is the diagnostic procedure of first choice. Generally accepted rules for intended curative pulmonary metastasectomy are control of the primary tumour, technically completely resectable metastases, the exclusion of extrapulmonary metastases except for potentially completely resectable hepatic metastases and a functional operability. The most important prognostic factors are complete resection, the exact entity of the tumour, disease-free interval and, to a limited extent, also the number of metastases. In bilateral disease sternotomy and sequentially staged or one-stage thoracotomy are the standard surgical approaches to be considered, whereby thoracotomy is more advantageous in cases of centrally located lesions and left lower lobe metastases. In unilateral disease, video-assisted resection may be considered under certain circumstances. Primary aim must be R0 resection. Tissue-sparing pulmonary dissection techniques are proposed besides anatomic resections. In particular in cases of centrally located or multiple lesions an extensive expertise in thoracic surgery is necessary to preserve as much functional lung parenchyma as possible. Secondary mediastinal lymph node involvement is associated with an adverse prognosis and should therefore be ruled out preoperatively. 10.1055/s-0031-1283958
Pulmonary metastasectomy. Nichols Francis C Thoracic surgery clinics The most common cause of cancer death is the development of metastatic disease. Thirty percent of patients eventually develop pulmonary metastases. Randomized control data supporting the commonly accepted practice of surgical pulmonary metastasectomy are lacking. This article focuses on the current surgical management of pulmonary metastases providing the reader with reasonable guidance from the vast literature that exists. 10.1016/j.thorsurg.2011.08.017
Pulmonary metastasectomy: review of experience at a tertiary cancer care center. Deo Suryanarayana S V,Shukla Nootan Kumar,Khanna Paras,Jha Deepak,Pandit Archit,Thulkar Sanjay Journal of cancer research and therapeutics BACKGROUND:Thirty to 40% of all extra thoracic cancers lead to secondary pulmonary lesions and approximately 20% of these cases feature metastases that are confined to the lungs. There is benefit of pulmonary metastasectomy in a select subset of patients. AIMS:The goal of this study was to evaluate the patient profile, treatment patterns, and outcomes following surgical treatment of lung metastasis and to identify prognostic factors for long-term survival. MATERIALS AND METHODS:Retrospective analysis of a prospectively maintained computerized database at a tertiary cancer care centre was done. 36 patients underwent curative resection for isolated pulmonary metastasis from January 1999 to December 2009. All metastasis were detected by non-contrast CT scan of the chest. Lung function tests were performed in all patients. Posterolateral thoracotomy was performed for resection of pulmonary metastasis by lung sparing procedures. A routine protocol of complete resection of all visible and palpable lung metastasis with a margin of 0.5 to 10 mm was followed in all patients. Staged thoracotomy was done for bilateral metastases. All palpable nodules were resected by wedge resection except in one case where pneumonectomy was done to achieve R0 resection. All patients underwent complete resection. CONCLUSIONS:Disease-free interval of more than 1 year along with less than 2 malignant nodules in patients with non-visceral pulmonary metastasis are variables identified in the present study which have enabled pulmonary metastasectomy to be offered as a safe therapeutic lifeline to patients. 10.4103/0973-1482.139153
[Pulmonary metastases - 12-year experience with surgical therapy]. Vodička J,Spidlen V,Simánek V,Safránek J,Fichtl J,Mukenšnabl P,Roušarová M Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti INTRODUCTION:Nowadays, radical surgical therapy of selected secondary pulmonary tumours is a generally accepted therapeutic procedure that has been proven to extend long-term survival of the patients with acceptable perioperative morbidity and mortality. The authors present a retrospective analysis of a set of patients who underwent surgery for pulmonary metastases of various tumours in a 12-year period. MATERIAL AND METHODS:In 2001-2012, 159 patients with secondary pulmonary tumours were operated on at the authors department, of whom 80 were men; the median age was 65 years. Solitary metastases were present in 112 patients (70.4%); the other patients had multiple metastases; 24 patients (15.1 %) suffered from bilateral involvement, and 6 patients (3.8%) suffered from relapsed metastatic disease after previous radical surgery. Colorectal carcinoma metastases were diagnosed in most cases (75 people - 47.2%). The median disease-free period from the surgery of the primary tumour was 27 months in the patient set. RESULTS:In total, 166 unilateral (87.4%) and 24 bilateral surgeries were performed using one- or two-stage procedure (12.6%). Precise laser excisions represented the most common type of surgery (59 procedures - 31.1%). In total, 296 metastases were radically resected, and 13 were treated using radiofrequency ablation. Perioperative morbidity was 13.2% with a zero lethality rate. 90 operated patients (56.6%) still survive after the metastasectomy, with median survival of 44 months. The overall 3-year survival in the set was 59%, and 5-year survival was 39%. The number of metastases is a statistically significant factor affecting survival in the patient cohort with colorectal carcinoma metastases, the risk of death being 2.7 times higher in patients with 2 and more colorectal carcinoma metastases. 68 patients (42.8%) live without progression of the disease after the metastasectomy, with the median disease-free interval of 29 months. In total, 43% of the patients were free of any signs of relapse or disease progression for 3 years, and 27% for 5 years. The risk of disease progression is 2.1 times higher in patients with 2 and more metastases of any tumour, and for colorectal carcinoma this risk is 2.3 times higher. CONCLUSION:The achieved results confirm the positive role of pulmonary metastasectomy in disseminated tumour therapy. The number of metastases is the decisive prognostic factor affecting both long-term survival of operated patients and their DFI.
Clinical characteristics and prognoses of patients treated surgically for metastatic lung tumors. Zhao Xiaoliang,Wen Xiaohua,Wei Wei,Chen Yulong,Zhu Jianquan,Wang Changli Oncotarget The clinical characteristics of metastatic lung tumors are not well understood. To explore the surgical indications, surgical modes, and factors that influence postoperative outcomes, we analyzed clinical data from 42 patients with metastatic lung tumors who received surgical treatment at Tianjin Medical University Cancer Institute and Hospital between January 2000 and January 2014. Gender, age, nature of resections, surgical mode, smoking index, disease-free intervals (DFIs), number of metastatic lesions, and lymph node metastases were analyzed. Patients were followed for 6 to 98 months. We found that surgical treatment is feasible for resectable metastatic lung tumors, though postoperative radiochemotherapy had no significant effect on postoperative survival rates among patients with metastatic lung tumors. No patients died perioperatively. The 1-year, 3-year, and 5-year survival rates after surgical resection of metastatic lung tumors were 88.1%, 45.7%, and 34.6%, respectively. Univariate analysis indicated that DFIs and lymph node metastasis correlated with patient prognoses, while multivariate analysis indicated these two variables were independent prognostic factors. Thus surgical treatment may be indicated, depending on patients' specific condition, to lengthen DFIs in patients with metastatic lung tumors with or without evident lymph node metastasis. 10.18632/oncotarget.14822
[Surgery of lung metastases]. Belda Sanchis José,Prenafeta Claramunt Núria,Martínez Somolinos Sandra,Figueroa Almánzar Santiago Archivos de bronconeumologia The aim of surgical treatment of lung metastases is to eliminate all known tumoral disease. After a clinical diagnosis of lung metastases, the criteria for selecting patients who are candidates for surgical treatment, the route of access to the thoracic cavity and the technique for metastases resection are not universally defined. Moreover, half of all patients will show recurrence and the advisability of further surgery will have to be reconsidered. The present article discusses aspects related to the oncological and functional limits of surgical resection of lung metastases, preoperative workup, postoperative follow-up, and the surgical approaches and resection techniques. 10.1016/S0300-2896(11)70022-9
Increasing survival of metastatic breast cancer through locoregional surgery. Díaz de la Noval Begoña,Frías Aldeguer Laura,Ángeles Leal García María,García López Enrique,Díaz Almirón Mariana,Herrera de la Muela María Minerva ginecologica BACKGROUND:Surgery for the primary tumor in metastatic breast cancer is usually not recommended, assuming that local therapy provides no advantage. Recent reports suggest a survival improvement after locoregional treatment, but this is still controversial. We aimed to evaluate the effectiveness of locoregional treatment in primary metastatic breast cancer and to determine associated factors. METHODS:A retrospective analysis of 39 women with de-novo metastatic breast cancer at La Paz University Hospital, from January 2012 to June 2016, grouped by locoregional treatment (n=23) or not (n=16). Multivariate assessment of prognostic factors was performed using Cox regression analysis. RESULTS:Mean tumor size was 6 cm. Eighteen patients (46.2%) had multifocal tumors, 29 (74.4%) multicentric and 10 (25.7%) bilateral breast cancer. Eighteen patients (46.2%) had an oligometastatic disease and 21 (53.8%) multiorgan metastatic disease. The average time from diagnosis to surgery was 7.7 months, without delay in the start of systemic treatment compared to the no-surgery group. The main surgical procedure was mastectomy in 18 (78.3%) patients. Half of the patients survived 48 months (95% CI: 39-57). In the multivariate analysis, we have not detailed differences in survival by age, chemotherapy, neoadjuvancy, number of systemic treatment lines, radiotherapy, and tumor histology or grade. However, surgery (HR=0.2; 95% CI: 0.07-0.57) and high tumor burden (HR=2.96, 95% CI: 1.23-7.13) have acted as a protective and a risk factor respectively. CONCLUSIONS:Our cohort supports that locoregional treatment in selected patients with de-novo MBC significantly improved survival, so it might be considered in combination with systemic therapy. 10.23736/S0026-4784.17.04097-7
Local therapy and survival in breast cancer with distant metastases. Noguchi Masakuni,Nakano Yasuharu,Noguchi Miki,Ohno Yukako,Kosaka Takeo Journal of surgical oncology This review article presents an evaluation of the effects of local therapy on survival of breast cancer patients with distant metastases along with a discussion of their relevance. Primary and recurrent breast cancers with distant metastases are systemic diseases with poor prognosis. However, several retrospective studies have demonstrated that surgical removal of the primary breast tumor has a favorable impact on the prognosis of stage IV breast cancer patients. Similarly, it has been reported that surgical resection of metastatic lesions in the lung as well as the liver yields unexpectedly promising results. The interaction of local treatment and systemic therapy may be important, because surgery and radiotherapy are only local treatments. However, it remains uncertain whether these encouraging findings are due to the surgical procedure itself or preoperative patient selection. Only a randomized prospective study can definitively show whether local treatment can prevent death from stage IV disease or recurrent breast cancer with distant metastases. Until data from prospective studies are available, clinicians must weigh retrospective experiences and clinical judgment in deciding whether to offer surgery or radiotherapy to these patients. 10.1002/jso.22056
Methods and results of local treatment of brain metastases in patients with breast cancer. Szadurska Agnieszka,Pluta Elżbieta,Walasek Tomasz,Blecharz Paweł,Jakubowicz Jerzy,Mituś Jerzy W Contemporary oncology (Poznan, Poland) This article presents methods and results of surgical treatment and radiation therapy of brain metastases in breast cancer patients (brain metastases from breast cancer BMF-BC). Based on the literature data, it was shown that patients with single BMF-BC, aged less than 65 years, with Karnofsky score (KPS) of 70 or more and with cured or controlled extracranial disease are the best candidates to surgical treatment. Irrespective of the extracranial disease control status, there are indications for surgery in patients with symptomatic mass effect (tumour diameter larger than 3 cm) and patients with obstructive hydrocephalus from their BMF-BC. Stereotactic radiosurgery (SRS) has some advantages over surgery, with similar effectiveness: it may be used in the treatment of lesions inaccessible to surgery, the number of lesion is not a limiting factor if each lesion is small (< 3) and adequate doses can be delivered, it is not contraindicated in patients with active extracranial disease, it does not interfere with ongoing systemic treatment, and it does not require general anaesthesia or hospitalisation. A disadvantage of SRS, as compared to whole brain radiotherapy (WBRT), in patients with BMF-BC is the possibility of subsequent development of new lesion in the non-irradiated field. Thus the majority of the BMF-BC patients are not good candidates to surgery or SRS; WBRT alone or combined with a systemic treatment still plays a major role in the treatment of these patients. 10.5114/wo.2016.65601
Locoregional surgical treatment improves the prognosis in primary metastatic breast cancer patients with a single distant metastasis except for brain metastasis. Li Xiaolin,Huang Run,Ma Lisi,Liu Sixuan,Zong Xiangyun Breast (Edinburgh, Scotland) BACKGROUND:We aimed to validate the clinical significance of locoregional surgery in improving the prognosis of primary metastatic breast cancer (pMBC). METHODS:We conducted a population-based retrospective study by analyzing clinical data obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. Stratification analysis was employed to assess the effect of breast surgery on breast cancer-specific survival and overall survival. Then propensity score matching and COX regression models were employed to evaluate the survival advantages of breast surgery, if any in patients with pMBC. RESULTS:The median BCSS and OS in the surgery group were almost twice of that in the group without surgery. Breast surgery provided a survival advantage for patients with a single metastasis in the bone, liver or lung, but not in the brain. We found that axillary lymph node dissection performed in combination with specific breast surgical procedures did not result in a significant improvement in survival. Additionally, when combined with radiotherapy and/or chemotherapy, surgery significantly improved the survival and was not influenced by the molecular subtype and tumor size. Finally, using COX regression models before and after propensity score matching, breast surgery was found to reduce the risk of mortality in patients with MBC by more than 40%. CONCLUSIONS:The effect of locoregional surgery has been underestimated in pMBC patients. Surgical procedures should be seriously considered when planning combination treatments for pMBC patients with a single metastasis except for brain metastasis. 10.1016/j.breast.2019.03.006
[Reoperation for Recurrent Pulmonary Metastases]. Sato Nobuyuki Kyobu geka. The Japanese journal of thoracic surgery From 1990 to 2019, 256 patients underwent surgery for metastatic lung tumors in our hospital, of which 23 (9.0%) had multiple surgeries. There were 15 cases of colorectal cancer, 2 cases of renal cancer, 2 cases of breast cancer, and 4 cases of others according to the primary lesion, and the number of operations was 2 times 18 cases, 3 times 4 cases, and 4 times 1 case. The average disease-free interval( DFI) was 27.2 months, and the average interval between the first and second operations was 25 months. The median observation period from the last surgery was 58.5 months, the 5-year survival rate was 67%, and the 10-year survival rate was 39%. If the surgical indication for metastatic lung tumor is satisfied and the prognostic factors such as long DFI or a small number of recurrences are met, re-surgery should be actively considered, and the significance of lung metastasectomy remains even now that drug therapy has advanced.
Breast Cancer Metastasis. Kim Mi Young Advances in experimental medicine and biology Owing to increased awareness of the importance of mammogram and advances in surgical technology, survival rate of patients with primary breast cancer has dramatically increased. Despite all these advances in breast cancer treatment, there are no currently available treatments for this disease once it metastasizes to distant organs including bones, lungs, brain, and liver. This is mainly attributed to the complexity of metastatic process. Recent advances in technology enabled cancer biologists to dissect each step of the metastatic process, and this led to discovery of major players and molecules in this process. In this section, we will discuss recent discovery and advances in the field of breast cancer metastasis research. 10.1007/978-981-32-9620-6_9