Original articleGeneral thoracicResection of Pulmonary Metastases From Sarcoma: Can Some Patients Benefit From a Less Invasive Approach?
Section snippets
Patient Selection
From January 2000 to July 2007, 113 consecutive patients underwent curatively intended lung resection for metastatic disease from sarcomas. Patients were selected for surgery if there was no recurrence at the primary site, no other metastastic sites, if all the detected pulmonary nodules were resectable without major functional compromise, and if they had increased in size but not in number during a surveillance period of at least 2 months. Among these 113 patients, we retrospectively
Results
The 31 patients in group TS had a total of 63 operations, 42 by thoracoscopy and 21 by thoracotomy. Staged bilateral resections were performed within less than a month in 11 patients (35%): in 7 patients, one side was treated by thoracoscopy and the other side by thoracotomy; and 4 patients underwent bilateral thoracoscopy. A total of 11 patients in group TS also had at least one resection performed by thoracotomy: in 7 patients before, and in 4 patients after, their thoracoscopic operation.
Comment
Over the past years, several studies have been published on thoracoscopic resection of PM [6, 7, 8, 9]. Video-assisted thoracic surgery has become an accepted modality in patients presenting with a limited number of lesions, usually fewer than two [10]. This attitude is based on lower morbidity after video-assisted thoracic surgery and its encouraging survival rate [7, 11].
However, very few authors have so far recommended a thoracoscopic approach for PM from sarcoma. In three recent series, all
References (26)
- et al.
Cost-effectiveness of pulmonary resection and systemic chemotherapy in the management of metastatic soft tissue sarcoma: a combined analysis from the University of Texas M. D. Anderson and Memorial Sloan-Kettering Cancer Centers
J Thorac Cardiovasc Surg
(2004) - et al.
Repeat resection of pulmonary metastases in patients with soft-tissue sarcoma
J Am Coll Surg
(2000) - et al.
Long term survival of thoracoscopic metastasectomy versus metastasectomy by thoracotomy in patients with a solitary pulmonary lesion
Eur J Surg Oncol
(2002) - et al.
Is finger palpation at operation indispensable for pulmonary metastasectomy in colorectal cancer?
Ann Thorac Surg
(2007) - et al.
Thoracoscopic localization techniques for patients with solitary pulmonary nodule and history of malignancy
Ann Thorac Surg
(2005) - et al.
Outcome of thoracoscopic pulmonary metastasectomy evaluated by confirmatory thoracotomy
Ann Thorac Surg
(2001) - et al.
Long-term survival after aggressive resection of pulmonary metastases among children and adolescents with osteosarcoma
J Pediatr Surg
(2006) - et al.
Computed tomographic scan of the chest underestimates the number of metastatic lesions in osteosarcoma
J Pediatr Surg
(2006) - et al.
Predictive factors for local recurrence of resected colorectal lung metastases
Ann Thorac Surg
(2005) - et al.
Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients
Ann Thorac Surg
(2006)
Prognostic role of lymph node involvement in lung metastasectomy
J Thorac Cardiovasc Surg
Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival
Ann Surg
Metastasectomy for soft tissue sarcomas
Cancer Treat Res
Cited by (104)
Pulmonary metastasectomy is associated with survival after lung-only recurrence in pancreatic cancer
2023, Surgery (United States)First live birth after uterine transposition
2023, Fertility and SterilityCurrent surgical management of children with osteosarcoma and pulmonary metastatic disease: A survey of the American Pediatric Surgical Association
2021, Journal of Pediatric SurgeryCitation Excerpt :Without tactile feel, thoracoscopy relies on preoperative and intraoperative nodule identification, and in many cases intraoperative localization techniques with wires, coils, dye or intraoperative ultrasound [17]. While thoracotomy remains the mainstay of pediatric practice, thoracoscopy is more widespread in adult patients owing to findings of comparable survival with decreased morbidity in selected patients with various sarcoma histologies [18]. However, no direct comparisons of the two surgical techniques have been performed in adult patients with osteosarcoma, and selection bias complicates interpretation because thoracoscopy is utilized more frequently for patients with better prognostic features (solitary, peripheral, and/or unilateral nodules).
Current Indications for Pulmonary Metastasectomy
2020, Surgical Oncology Clinics of North AmericaCitation Excerpt :Furthermore, modern high-resolution CT scanning with 1-mm slices has vastly improved detection of subcentrimeter nodules, with sensitivity of 97% and negative predictive value of 96%,19 obviating bimanual palpation. Current studies demonstrate comparable rates in survival and cancer recurrence between VATS and open techniques of between 30.6% and 69%.20,21 Given no apparent survival difference, the clinical significance of resection of radiologically undetected metastases is questionable.
Multicenter Phase II Clinical Trial of Isolated Lung Perfusion in Patients With Lung Metastases
2019, Annals of Thoracic SurgeryGynecological sarcomas, surgical management: primary, metastatic, and recurrent disease
2024, International Journal of Gynecological Cancer