Abstract
Background
Extended resections may be necessary to achieve tumor-free borders for secondary pulmonary malignancies. This study was performed to analyze the outcomes that result from extended resections of pulmonary metastases.
Methods
Between February 1991 and December 2008, a total of 25 extended pulmonary resections (resection of the chest wall and diaphragm, vascular procedures, sleeve resections, pneumonectomies, atrial resections, and completion pneumonectomies) were performed on 250 patients undergoing 319 metastasectomy procedures. The extended resection group was analyzed in terms of disease-free interval, type of resection, operative morbidity, mortality, and survival and was then compared with patients who underwent lobar or sublobar resections.
Results
The extended resection group consisted of 14 male and 11 female patients. The mean disease-free interval was 36.02 (minimum 6, maximum 132) months. The extended resection rate was 10%. After 30 days, all patients were alive. For all extended metastasectomy groups, actuarial 5-year survival rates from the time of the extended metastasectomy were 16.3%. Mean survival times of patients who underwent extended resection and lobar or sublobar resection were 40 months (SD = 11) (95% confidence interval, 19–61) and 20 months (SD = 3) (95% confidence interval, 14–26), respectively. This difference was not statistically significant (P = 0.09) (Fig. 2). In the subgroup analysis, survival in the extended resections and lobar or sublobar resections groups was not statistically significant (osteosarcoma, P = 0.758; epithelial tumor, P = 0.11).
Conclusions
Extended resections, which can be performed during pulmonary metastasectomies of patients with tumor-free surgical borders, may establish curative benefits, with low rates of mortality and morbidity.
Similar content being viewed by others
References
Koehne CH, Cunningham D, Costanzo Di, et al. Clinical determinants of survival in patients with 5-fluorourocil-based treatment for metastatic colorectal cancer: results of a multivariate analysis of 3825 patients. Ann Oncol. 2002;10:308–17.
Barney JE, Churchill EJ. Adenocarcinoma of the kidney with metastasis to the lung cured by nephrectomy and lobectomy. J Urol. 1939;42:269–76.
Rusch VW. Pulmonary metastasectomy. Current indications. Chest. 1995;107:322–31.
Friedel G, Pastorino U, Buyse M, et al. Resection of lung metastases: long term results and prognostic analysis based on 5206 cases—the International Registry of Lung Metastases. Zentralbl Chir. 1999;124:96–103.
Poncelet JA, Lurguin A, Weynand B, Humblet Y, Noirhomme P. Prognostic factors for long term survival in patients with thoracic metastaic disease: a 10 year experience. Eur J Cardiothorac Surg. 2007;31:173–80.
Pastorino U, Buyse M, Friedel G, et al. for The International Registry of Lung Metastases. Long term results of lung metastasectomy: prognostic analysis based on 5206 cases. J Thorac Cardiovasc Surg. 1997;113:37–49.
Internullo E, Cassivi SD, Raemdonk DV, Friedel G, Treasure T, on behalf of the ESTS Pulmonary Metastasectomy Working Group. Pulmonary metastasectomy. A survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2008;3:1257–62.
Jungraithmayr W, Hasse J, Stoelben E. Completion pneumonectomy for lung metastases. Eur J Surg Oncol. 2004;30:1113–7.
Guggino G, Doddoli C, Barlesi F, et al. Completion pneumonectomy in cancer patients: experience with 55 cases. Eur J Cardiothorac Surg. 2004;25:449–55.
Koong HN, Pastorino U, Ginsberg RJ, for the International Registry of Lung Metastases. Is there a role for pneumonectomy in pulmonary metastases? Ann Thorac Surg. 1999;68:2039–43.
Spaggiari L, Grunenwald DH, Girard P, Solli P, Chevalier TL. Pneumonectomy for lung metastases: indications, risks, and outcome. Ann Thorac Surg. 1998;66:1930–3.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tanju, S., Ziyade, S., Erus, S. et al. Extended Resection: Is It Feasible for Pulmonary Metastases?. Ann Surg Oncol 17, 1912–1916 (2010). https://doi.org/10.1245/s10434-010-0960-0
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-010-0960-0