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Pulmonary Metastasectomy: Role of Pulmonary Metastasectomy and Type of Surgery

  • Sarcoma (SH Okuno, Section Editor)
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Opinion statement

Patients with untreated metastatic disease have a less than 5 % to 10 % 5-year survival, and for the patient who has metastatic disease isolated to the lungs, pulmonary metastasectomy remains the best hope for cure. Pulmonary metastasectomy has been performed for decades. However, despite hundreds of studies spanning several decades, randomized control data in support of pulmonary metastasectomy is still lacking, and the evidence upon which we base this commonly accepted surgical practice is for the most part weak. While well-accepted surgical selection criteria exist, controversies related to pulmonary metastasectomy abound. Unanswered and clearly debatable are questions related to: optimal preoperative imaging, if mediastinal staging should be performed and if so when, is video-assisted thoracic surgery (VATS) equivalent to open thoracotomy, is finger palpation of the lung mandatory, is repeat pulmonary metastasectomy justified, and what is the interrelationship of pulmonary metastasectomy to other treatments. Current practice to the surgical approach to pulmonary metastasectomy remains quite variable.

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References and Recommended Reading

  1. Davidson RS, Nwogu CE, Brentjens MJ, et al. The surgical management of pulmonary metastasis: current concepts. Surg Oncol. 2001;10:35–42.

    Article  CAS  PubMed  Google Scholar 

  2. American Cancer Society. Cancer facts and figures 2014. Atlanta: American Cancer Society; 2014.

    Google Scholar 

  3. Potter DA, Glenn J, Kinsella T, et al. Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol. 1985;3:353–66.

    CAS  PubMed  Google Scholar 

  4. Rehders A, Hosch SB, Scheunemann P, et al. Benefit of surgical treatment of lung metastasis in soft tissue sarcoma. Arch Surg. 2007;142:70–5.

    Article  PubMed  Google Scholar 

  5. Coindre JM, Terrier P, Guillou L, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas. Cancer. 2001;91:1914–26.

    Article  CAS  PubMed  Google Scholar 

  6. Thornton K, Pesce CE, Choti MA. Multidisciplinary management of metastatic sarcoma. Surg Clin N Am. 2008;88:661–72.

    Article  PubMed  Google Scholar 

  7. Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localized resectable soft-tissue sarcoma of adults, meta-analysis of individual data. Lancet. 1997;350:1647–54.

    Article  Google Scholar 

  8. Ripley RT, Downey RJ. Pulmonary metastasectomy. J Surg Oncol. 2014;109:42–6.

    Article  PubMed  Google Scholar 

  9. Smith R, Demmy TL. Pulmonary metastasectomy for soft tissue sarcoma. Surg Oncol Clin N Am. 2012;21:269–86.

    Article  PubMed  Google Scholar 

  10. Italiano A, Mathoulin-Pelissier S, Cesne AL, et al. Trends in survival for patients with metastatic soft-tissue sarcoma. Cancer. 2011;117:1049–54.

    Article  PubMed  Google Scholar 

  11. Blay JY, van Glabbeke M, Verweij J, et al. Advanced soft-tissue sarcoma: a disease that is potentially curable for a subset of patients treated with chemotherapy. Eur J Cancer. 2003;39:64–9.

    Article  PubMed  Google Scholar 

  12. Billingsley KG, Burt ME, Jara E, et al. Pulmonary metastases from soft tissue sarcoma: analysis of diseases and postmetastasis survival. Ann Surg. 1999;229:602–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Billingsley KG, Lewis JJ, Leung DH, et al. Multifactorial analysis of the survival of patients with distant metastasis arising from primary extremity sarcoma. Cancer. 1999;85:389–95.

    Article  CAS  PubMed  Google Scholar 

  14. Martini N, McCormack PM. Evolution of the surgical management of pulmonary metastases. Chest Surg Clin N Am. 1998;8:13–27.

    CAS  PubMed  Google Scholar 

  15. Nichols FC. Pulmonary metastasectomy. Thorac Surg Clin. 2012;22:91–9.

    Article  PubMed  Google Scholar 

  16. Pastorino U, Buyse M, Friedel G, et al. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg. 1997;113:37–49.

    Article  Google Scholar 

  17. Allen MS, Putnam Jr JB. Secondary tumors of the lung. In: Shields TW, LoCicero J, Reed CE, Feins RH, editors. General thoracic surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 1619–46.

    Google Scholar 

  18. Pastorino U, Grunenwald D. Surgical resection of pulmonary metastases. In: Patterson GA, Cooper JD, Deslauriers J, Lerut A, Luketich JD, Rice TW, editors. Pearson’s thoracic and esophageal surgery. 3rd ed. Philadelphia: Churchill Livingstone Elsevier; 2008. p. 851–63.

    Chapter  Google Scholar 

  19. Rusch VW. Pulmonary metastasectomy a moving target. J Thorac Oncol. 2010;5:S130–1.

    Article  PubMed  Google Scholar 

  20. Van Raemdonck D, Friedel G. The European Society of Thoracic Surgeons lung metastasectomy project. J Thorac Oncol. 2010;5:S127–9.

    Article  PubMed  Google Scholar 

  21. Internullo E, Cassivi SD, Van Raemdonck D, et al. Pulmonary metastasectomy a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2008;3:1257–66.

    Article  PubMed  Google Scholar 

  22. Kon Z, Martin L. Resection for thoracic metastases from sarcoma. Oncology. 2011;25:1198–204.

    PubMed  Google Scholar 

  23. Rusch VW. Pulmonary metastasectomy: current indications. Chest. 1995;107:322S–32.

    Article  CAS  PubMed  Google Scholar 

  24. Blackmon SH, Shah N, Roth JA, et al. Resection of pulmonary and extrapulmonary sarcomatous metastases is associated with long-term survival. Ann Thorac Surg. 2009;88:877–85.

    Article  PubMed  Google Scholar 

  25. Fortes DL, Allen MS, Lowe VJ, et al. The sensitivity of 18F-fluorodeoxyglucose positron emission tomography in the evaluation of metastatic pulmonary nodules. Eur J Cardiothorac Surg. 2008;34:1223–7.

    Article  PubMed  Google Scholar 

  26. Detterbeck FC, Grodzki T, Gleeson F, et al. Imaging requirements in the practice of pulmonary metastasectomy. J Thorac Oncol. 2010;5:S134–9.

    Article  PubMed  Google Scholar 

  27. Ercan S, Nichols III FC, Trastek VF, et al. Prognostic significance of lymph node metastasis found during pulmonary metastasectomy for extrapulmonary carcinoma. Ann Thorac Surg. 2004;77:1786–91.

    Article  PubMed  Google Scholar 

  28. Loehe F, Kobinger S, Hatz RA, et al. Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy. Ann Thorac Surg. 2001;72:225–9.

    Article  CAS  PubMed  Google Scholar 

  29. Pfannschmidt J, Klode J, Muley T, et al. Nodal involvement at the time of pulmonary metastasectomy: experience in 245 patients. Ann Thorac Surg. 2006;81:448–54.

    Article  PubMed  Google Scholar 

  30. Molnar TF, Gebitekin C, Turna A. What are the considerations in the surgical approach in pulmonary metastasectomy? J Thorac Oncol. 2010;5:S140–4.

    Article  PubMed  Google Scholar 

  31. McCormack PM, Ginsberg KB, Bains MS, et al. Accuracy of lung imaging in metastases with implications for the role of thoracoscopy. Ann Thorac Surg. 1993;56:863–5.

    Article  CAS  PubMed  Google Scholar 

  32. McCormack PM, Bains MS, Begg CB, et al. Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial. Ann Thorac Surg. 1996;62:213–6.

    Article  CAS  PubMed  Google Scholar 

  33. Ellis MC, Hessman CJ, Weerasinghe R, et al. Comparison of pulmonary nodule detection rates between preoperative CT imaging and intraoperative lung palpation. Am J Surg. 2011;201:619–22.

    Article  PubMed  Google Scholar 

  34. Cerfolio RJ, Bryant AS, McCarty TP, et al. A prospective study to determine the incidence of non-malignant pulmonary nodules in patients who undergo metastasectomy by thoracotomy with lung palpation. Ann Thorac Surg. 2011;91:1696–701.

    Article  PubMed  Google Scholar 

  35. Parsons AM, Detterbeck FC, Parker LA. Accuracy of helical CT in the detection of pulmonary metastases: is intraoperative palpation still necessary? Ann Thorac Surg. 2004;78:1910–8.

    Article  PubMed  Google Scholar 

  36. Parsons AM, Ennis EK, Yankaskas BC, et al. Helical computed tomography inaccuracy in the detection of pulmonary metastases: can it be improved? Ann Thorac Surg. 2007;84:1830–7.

    Article  PubMed  Google Scholar 

  37. Eckhardt JM, Licht PB. Thoracoscopic versus open pulmonary metastasectomy a prospective, sequentially controlled study. Chest. 2012;142:1598–602.

    Article  Google Scholar 

  38. Long H, Zheng Y, Situ D, et al. Hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through sternocostal triangle access. Ann Thorac Surg. 2011;91:852–9.

    Article  PubMed  Google Scholar 

  39. Detterbeck FC, Egan TM. Thoracoscopy using a substernal handport for palpation. Ann Thorac Surg. 2004;78:1031–6.

    Article  PubMed  Google Scholar 

  40. Mibeo TC, Ambrogi V, Paci M, et al. Transxiphoid bilateral palpation in video-assisted thoracoscopic lung metastasectomy. Arch Surg. 2001;136:783–8.

    Article  Google Scholar 

  41. Nakas A, Klimatsides MN, Entwisle J, et al. Video-assisted versus open pulmonary metastasectomy: the surgeon’s finger or the radiologist’s eye? Eur J Cardiothorac Surg. 2009;36:469–74.

    Article  PubMed  Google Scholar 

  42. Mutsaerts EL, Zoetmulder FA, Meijer S, et al. Long term survival of thoracoscopic metastasectomy vs. metastasectomy by thoracotomy in patients with a solitary pulmonary lesion. Eur J Surg Oncol. 2002;28:864–8.

    Article  CAS  PubMed  Google Scholar 

  43. Carballo M, Maish MS, Jaroszewski DE, et al. Video-assisted thoracic surgery (VATS) as a safe alternative for the resection of pulmonary metastases: a retrospective cohort study. J Cardiothorac Surg. 2009;4:13.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Gossot D, Radu C, Girard P, et al. Resection of pulmonary metastases from sarcoma: can some patients benefit from a less invasive approach? Ann Thorac Surg. 2009;87:238–43.

    Article  PubMed  Google Scholar 

  45. Roth JA, Pass HJ, Wesley MN, et al. Comparison of median sternotomy and thoracotomy for resection of pulmonary metastases in patients with adult soft-tissue sarcomas. Ann Thorac Surg. 1986;42:134–8.

    Article  CAS  PubMed  Google Scholar 

  46. Younes RN, Gross JL, Deheinzelin D. Surgical resection of unilateral lung metastasis: is bilateral thoracotomy necessary? World J Surg. 2002;26:1112–6.

    Article  PubMed  Google Scholar 

  47. Koong HN, Pastorino U, Ginsberg RJ. Is there a role for pneumonectomy in pulmonary metastases? Ann Thorac Surg. 1999;68:2039–43.

    Article  CAS  PubMed  Google Scholar 

  48. McGovern EM, Trastek VF, Pairolero PC, et al. Completion pneumonectomy: indications, complications, and results. Ann Thorac Surg. 1988;46:141–6.

    Article  CAS  PubMed  Google Scholar 

  49. Spaggiari L, Grunenwald DH, Girard P. Pneumonectomy for lung metastases: indications, risks, and outcomes. Ann Thorac Surg. 1998;66:1930–3.

    Article  CAS  PubMed  Google Scholar 

  50. Pairolero PC. Invited commentary: pneumonectomy for lung metastases: indications, risks, and outcomes. Ann Thorac Surg. 1998;66:1930–3.

    Article  Google Scholar 

  51. Pastorino U. Lung metastasectomy why, when, how. Crit Rev Oncol Hematol. 1997;26:137–45.

    Article  CAS  PubMed  Google Scholar 

  52. Kager L, Zoubeck A, Potschger U, et al. Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols. J Clin Oncol. 2003;21:2011–8.

    Article  PubMed  Google Scholar 

  53. Harting MT, Blakely ML, Jaffe N, et al. Long-term survival after aggressive resection of pulmonary metastases among children and adolescents with osteosarcoma. J Pediatr Surg. 2006;41:194–9.

    Article  PubMed  Google Scholar 

  54. Kim S, Ott H, Wright C, et al. Pulmonary resection of metastatic sarcoma: prognostic factors associated with improved outcomes. Ann Thorac Surg. 2011;92:1780–7.

    Article  PubMed  Google Scholar 

  55. Weiser MR, Downey RJ, Leung DH, et al. Repeat resection of pulmonary metastases in patients with soft tissue sarcoma. J Am Coll Surg. 2000;191:184–90.

    Article  CAS  PubMed  Google Scholar 

  56. Jaklitsch MT, Mery CM, Lukanich JM, et al. Sequential thoracic metastasectomy prolongs survival by re-establishing local control within the chest. J Thorac Cardiovasc Surg. 2001;121:657–67.

    Article  CAS  PubMed  Google Scholar 

  57. Migliore M, Jakovic R, Hensens A, Klepetko W. Extending surgery for pulmonary metastasectomy: What are the limits? J Thorac Oncol. 2010;5:S155–60.

    Article  PubMed  Google Scholar 

  58. Garcia-Yuste M, Cassivi S, Paleru C. Thoracic lymphatic involvement in patients having pulmonary metastasectomy. J Thorac Oncol. 2010;5:S166–9.

    Article  PubMed  Google Scholar 

  59. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: Initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81:1013–9.

    Article  PubMed  Google Scholar 

  60. Welter S, Jacobs J, Krbek T, et al. Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg. 2007;31:167–72.

    Article  PubMed  Google Scholar 

  61. Kondo H, Okumura T, Ohde Y, et al. Surgical treatment for metastatic malignancies. Pulmonary metastasis: indications and outcomes. Int J Clin Oncol. 2005;10:81–5.

    Article  PubMed  Google Scholar 

  62. Kaifi JT, Gusani NJ, Deshaives I, et al. Indications and approach to surgical resection of lung metastases. J Surg Oncol. 2010;102:187–95.

    Article  PubMed  Google Scholar 

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Francis C. Nichols declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Francis C. Nichols M.D.

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Nichols, F.C. Pulmonary Metastasectomy: Role of Pulmonary Metastasectomy and Type of Surgery. Curr. Treat. Options in Oncol. 15, 465–475 (2014). https://doi.org/10.1007/s11864-014-0300-x

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