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1
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Jones GD, Murthy S. Pulmonary Metastasectomy in Renal Cell Carcinoma. Thorac Surg Clin 2025; 35:175-187. [PMID: 40246407 DOI: 10.1016/j.thorsurg.2024.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2025]
Abstract
Recent advances in immunotherapy and targeted therapy have resulted in survival rates as high as 90% at 1 year in metastatic renal cell carcinoma patients; however, sustained response and ultimate cure is rarely achieved with systemic therapy alone (complete response rates remain <5%), and progression of disease at distant sites is common. Pulmonary metastasectomy is recommended as a component of multimodal management in patients with favorable-risk or intermediate-risk classification and can be associated with excellent survival if complete resection is obtained.
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Affiliation(s)
- Gregory D Jones
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA. https://twitter.com/GregoryJonesMD
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA; Center of Major Airway Disease, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA.
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2
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Baar W, Semmelmann A, Anselm F, Loop T, Heinrich S. Risk Factors for Postoperative Pulmonary Complications in Patients Undergoing Thoracotomy for Indications Other than Primary Lung Cancer Resection: A Multicenter Retrospective Cohort Study from the German Thorax Registry. J Clin Med 2025; 14:1565. [PMID: 40095485 PMCID: PMC11901112 DOI: 10.3390/jcm14051565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 02/13/2025] [Accepted: 02/24/2025] [Indexed: 03/19/2025] Open
Abstract
Background: Postoperative pulmonary complications (PPCs) are the most common complications following lung surgery and can lead to increased postoperative mortality. In this study, we examined the incidence of PPCs, the in-hospital mortality rate, and the risk factors associated with PPCs in patients undergoing open thoracotomy lung resection (OTLR) for reasons other than primary lung cancer. Methods: Data from this multicenter, retrospective study involving 1.368 patients were extracted from the German Thorax Registry and analyzed using univariate and multivariable statistical methods. Results: In total, 278 patients showed at least one PPC. The presence of PPCs was associated with a significantly higher in-hospital mortality rate (7.2% vs. 1.5%; p = 0.000). Multivariable stepwise logistic regression analysis showed absolute age (OR 1.02) and BMI ≤ 19 (OR 2.6) as independent patient-specific risk factors. Significant preoperative risk factors included re-thoracotomy (OR 4.0) and FEV1 < 60% (OR 2.5). Procedure-related independent risk factors for PPCs included a surgical duration surpassing 195 min (OR 2.7), the continuation of invasive ventilation post-surgery (OR 3.8), and an intraoperative infusion of crystalloids greater than 6 mL/kg/h (OR 1.8). Conclusions: Optimizing intraoperative fluid therapy and on-table extubation when possible may reduce the incidence of PPCs and associated mortality.
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Affiliation(s)
- Wolfgang Baar
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.S.); (F.A.); (T.L.); (S.H.)
| | - Axel Semmelmann
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.S.); (F.A.); (T.L.); (S.H.)
| | - Florian Anselm
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.S.); (F.A.); (T.L.); (S.H.)
| | - Torsten Loop
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.S.); (F.A.); (T.L.); (S.H.)
| | - Sebastian Heinrich
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.S.); (F.A.); (T.L.); (S.H.)
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Shalabi A, Shalabi SF, Graeter T, Welter S, Ehab A, Kuon J. Low Rates of Intrapulmonary Local Recurrence After Laser Metastasectomy: A Single-Center Retrospective Cohort Study of Colorectal Cancer Metastases. Cancers (Basel) 2025; 17:683. [PMID: 40002277 PMCID: PMC11852527 DOI: 10.3390/cancers17040683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 02/09/2025] [Accepted: 02/14/2025] [Indexed: 02/27/2025] Open
Abstract
Objective: Colorectal pulmonary metastasis is the most common resected metastatic disease of the lung. Pulmonary metastasectomy (PM) for colorectal oligometastases is a well-established intervention with curative intent. Local recurrence at the resection site in the lung is a problem, with an impact on survival. The use of a 1320 nm neodymium:yttrium aluminum garnet (Nd:YAG) laser causes the vaporization and coagulation at the resection line and thereby increases safety margins around the nodule. We aimed to evaluate the local recurrence rate after laser-assisted pulmonary metastasectomy (LPM) for colorectal metastases. Methods: We conducted a retrospective analysis of 49 patients treated with laser-assisted pulmonary metastasectomy for 139 metastatic nodules from colorectal cancer from 2010 to 2018. All nodules were resected using Nd:YAG 1320 nm laser, aiming for a safety margin of five mm. The minimum follow-up time after PM was 24 months. Results: Local intrapulmonary recurrence developed at 7 of the 139 (5.0%) resection sites in 5 of the 49 patients (10.2%). Microscopically incomplete resection was a significant risk factor for recurrence (p = 0.023). Larger nodule size (>12 mm) negatively impacted local recurrence (p = 0.024). Nodules larger or equal to 12 mm in size also lowered the patients' probability of survival by 67.29% (HR: 0.3271, 95% CI: 0.1265-0.846, p = 0.018). Conclusions: The rate of local recurrence at the resection site after LPM for colorectal metastases is low. Complete resection is a positive predictor of survival without local recurrence. Microscopic complete resection with the addition of vaporization and coagulation at the resection margin seems to be sufficient to prevent local recurrence. However, larger nodules may require larger safety margins.
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Affiliation(s)
- Ahmad Shalabi
- Thoracic and Vascular Surgery Department, SLK Lungenklinik Löwenstein, 74245 Löwenstein, Germany
| | - Sundus F. Shalabi
- Faculty of Medicine, Arab American University, Jenin P.O. Box 240, Palestine;
| | - Thomas Graeter
- Thoracic and Vascular Surgery Department, SLK Lungenklinik Löwenstein, 74245 Löwenstein, Germany
| | - Stefan Welter
- Department of Thoracic Surgery, Lungenklinik Hemer, 58675 Hemer, Germany;
| | - Ahmed Ehab
- Pulmonary Medicine Department, SLK Lungenklinik Löwenstein, 74245 Löwenstein, Germany
- Pulmonary Medicine Department, Mansoura University, Mansoura 35511, Egypt
| | - Jonas Kuon
- Department of Thoracic Oncology, SLK Lungenklinik Löwenstein, 74245 Löwenstein, Germany
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4
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Tasoudis P, Manaki V, Parness S, Khoury AL, Agala CB, Haithcock BE, Mody GN, Long JM. The Role of Metastasectomies and Immunotherapy in the Management of Melanoma Lung Metastases: An Analysis of the National Cancer Database. Cancers (Basel) 2025; 17:206. [PMID: 39857988 PMCID: PMC11763692 DOI: 10.3390/cancers17020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 01/02/2025] [Accepted: 01/06/2025] [Indexed: 01/27/2025] Open
Abstract
INTRODUCTION Patients with metastatic melanoma to the lung typically have poor outcomes. Although a pulmonary metastasectomy for selected patients has been shown to improve survival, the role of surgical resection following the introduction of immunotherapy for metastatic melanoma is unknown. The objective of this study was to determine predictors of survival for patients with melanoma metastatic to the lung in the era of immunotherapy. METHODS In this retrospective study, data from the National Cancer Database were abstracted for patients with melanoma lung metastases. The overall survival was evaluated using Kaplan-Meier and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality. Patients with concomitant metastases to organs other than the lung were excluded from the study. RESULTS A total of 625 patients with lung metastases at the time of a skin melanoma diagnosis were identified. A total of 280 patients underwent a pulmonary metastasectomy, 267 received immunotherapy, and 78 were treated with both a metastasectomy and immunotherapy. During a median follow-up time of 34.6 months [IQR: 14.2, 75.9], a metastasectomy was found to offer significantly improved survival compared to immunotherapy alone. No difference was noted between a metastasectomy and a combination of a metastasectomy and immunotherapy in the adjusted Cox proportional hazard model. CONCLUSIONS When statistical models were adjusted for risk factors, a metastasectomy maintained a significant survival advantage compared to immunotherapy. The addition of immunotherapy to the treatment of patients treated with a pulmonary metastasectomy did not improve survival. Our findings support the role of surgery for patients with pulmonary metastatic melanoma.
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Affiliation(s)
- Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.P.); (A.L.K.); (B.E.H.); (G.N.M.); (J.M.L.)
| | - Vasiliki Manaki
- School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Shannon Parness
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.P.); (A.L.K.); (B.E.H.); (G.N.M.); (J.M.L.)
| | - Audrey L. Khoury
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.P.); (A.L.K.); (B.E.H.); (G.N.M.); (J.M.L.)
| | - Chris B. Agala
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Benjamin E. Haithcock
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.P.); (A.L.K.); (B.E.H.); (G.N.M.); (J.M.L.)
| | - Gita N. Mody
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.P.); (A.L.K.); (B.E.H.); (G.N.M.); (J.M.L.)
| | - Jason M. Long
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.P.); (A.L.K.); (B.E.H.); (G.N.M.); (J.M.L.)
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Woo W, Park B, Ahadi A, Chung LIY, Jung CM, Bharat A, Chae YK. The Role of Pulmonary Metastasectomy for Non-Primary Lung Cancer: Umbrella Review of Meta-Analyses. J Surg Oncol 2024. [PMID: 39674949 DOI: 10.1002/jso.28033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 11/16/2024] [Indexed: 12/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Due to heterogeneous characteristics of primary cancers, the efficacy of pulmonary metastasectomy (PM) in nonprimary lung cancers has not been investigated. This study aims to investigate the clinical outcomes of PM for non-primary lung cancer. METHODS A systematic search for meta-analyses on PM for nonprimary lung cancers was conducted, encompassing publications up to January 3, 2024. This included seven primary cancers: renal cell, breast, adrenocortical, head and neck cancers, melanoma, germ cell tumors, and sarcoma. Overall survival and recurrence rates post-PM were assessed using random-effect models. RESULTS This study included 16 systematic-review articles and 101 individual studies, involving 10 277 patients who underwent PM for nonprimary lung cancer. About half of the patients (47.1%) presented with multiple metastasis, and complete resection achieved in 87.2% [95% CI: 83.0-90.8]. The pooled 5-year overall survival rate post-PM was 41.2% [95%CI: 37.1%-45.4%]. Patients with germ cell tumors demonstrated higher survival rate (p < 0.05), while melanoma exhibited the worst outcome (p < 0.05). During follow-up, 57.6% [95% CI: 46.4-68.1] had recurrence; 48% of them had intrathoracic-only recurrence. CONCLUSION This study underscores the survival benefits associated with PM. Overall survival rates following PM did not differ based on primary cancer types. These findings highlight the importance of recognizing and incorporating PM into clinical practice when appropriate.
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Affiliation(s)
- Wongi Woo
- Department of Internal Medicine, Dignity Health St. Joseph Medical Center Stockton, Stockton, California, USA
| | - Brandon Park
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Awranoos Ahadi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Liam Il-Young Chung
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Chan Mi Jung
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ankit Bharat
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Young Kwang Chae
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Yoshida M, Oura S. Low Fluorodeoxyglucose Uptake in the Metastatic Lung Tumor From Clear Cell Renal Cell Carcinoma. Cureus 2024; 16:e67854. [PMID: 39328703 PMCID: PMC11424220 DOI: 10.7759/cureus.67854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2024] [Indexed: 09/28/2024] Open
Abstract
A 78-year-old man had undergone laparoscopic left nephrectomy for clear cell renal cell carcinoma (CCRCC) and, three years later, partial resection for a lung metastasis of CCRCC. Follow-up computed tomography (CT) again showed a solitary oval lung nodule that was adjacent to the pulmonary vein, leading to careful CT follow-up without trans-bronchial lung biopsy. The lung nodule grew rapidly from 18 mm to 25 mm in a year. However, positron emission tomography showed only a slight increase in the maximal standardized uptake value (SUV max) of 3.76 g/mL. Under the tentative diagnosis of a metastatic lung tumor from CCRCC, the patient underwent lung wedge resection for the presumed lung metastasis. A postoperative pathological study showed a well-circumscribed oval tumor consisting of atypical cells with clear cytoplasm and densely growing in an expansive manner. Immunostaining using paraffin-embedded tissue showed that lipid droplets were observed on the tumor cells and periodic-acid Schiff (PAS)-positive granules were confirmed in the cytoplasm of the atypical cells. Oncologists should note that the SUV max value of metastatic lung tumors from CCRCC is ostensibly low due to the presence of intracytoplasmic lipids and glycogen.
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Affiliation(s)
- Mami Yoshida
- Surgery, Kishiwada Tokushukai Hospital, Kishiwada, JPN
| | - Shoji Oura
- Surgery, Kishiwada Tokushukai Hospital, Kishiwada, JPN
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Giulia O, Alessandro B, Angelo C, Paolo M, Rosa C, Marina M, Umberto P, Catia C, Giulia V, Massimo F, Michele R. Isolated lung metastases from pancreatic ductal adenocarcinoma (PDAC): Diagnostic and therapeutic challenges of a different disease. Semin Oncol 2024; 51:69-76. [PMID: 38879350 DOI: 10.1053/j.seminoncol.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 08/04/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, mostly due to the high rate of distant dissemination. However, growing evidence shows that isolated lung recurrence or metastases (ILM) from PDAC are not only less common, but also correlated with a better prognosis. Lung-only recurrence after surgery occurs later in time and is associated with more favorable prognostic characteristics of the primary tumor. Moreover, recent findings suggest that this specific site of metastases is characterized by an immunologically "hot" microenvironment and a more favorable molecular profile that could possibly justify its clinical behavior. Thus, ILM from PDAC emerge as a distinct entity, that might also benefit from a different therapeutic approach, possibly with the integration of surgery and de-intensified chemotherapy regimens, especially in selected patients. In this review we delve into the current scientific evidence on the clinical and biological characteristics of isolated LM from PDAC, also focusing on concerns with their diagnostic process and the therapeutic options for the management of this subset of patients.
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Affiliation(s)
- Orsi Giulia
- Department of Medical Oncology, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bandiera Alessandro
- Department of Thoracic Surgery, Vita- Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carretta Angelo
- Department of Thoracic Surgery, Vita- Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Migliori Paolo
- Medical Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Chavez Rosa
- Department of Medical Oncology, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Macchini Marina
- Department of Medical Oncology, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Peretti Umberto
- Department of Medical Oncology, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carconi Catia
- Department of Medical Oncology, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronesi Giulia
- Department of Thoracic Surgery, Vita- Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Falconi Massimo
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, Vita -Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Reni Michele
- Department of Medical Oncology, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Shalabi A, Ehab A, Shalabi SF, Kugler G, Schäfers HJ, Graeter T. Laser assisted pulmonary metastasectomy promises a low local recurrence rate. Sci Rep 2024; 14:5988. [PMID: 38472291 DOI: 10.1038/s41598-024-56566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
Pulmonary metastasectomy (PM) is consensually performed in a parenchyma-sparing manner to preserve functionally healthy lung tissue. However, this may increase the risk of local recurrence at the surgical margin. Laser assisted pulmonary metastasectomy (LPM) is a relatively recent innovation that is especially useful to resect multiple metastatic pulmonary nodules. In this study we investigated the rate of local recurrence after LPM and evaluated the influence of various clinical and pathological factors on local recurrence. Retrospectively, a total of 280 metastatic nodules with different histopathological entities were studied LPM from 2010 till 2018. All nodules were resected via diode-pumped neodymium: yttrium-aluminum-garnet (Nd:YAG) 1,318 nm laser maintaining a safety margin of 5 mm. Patients included were observed on average for 44 ± 17 months postoperatively. Local recurrence at the surgical margin following LPM was found in 9 nodules out of 280 nodules (3.21%). Local recurrence at the surgical margin occurred after 20 ± 8.5 months post operation. Incomplete resection (p = < 0.01) and size of the nodule (p = < 0.01) were associated with significantly increased risk of local recurrence at the surgical margin. Histology of the primary disease showed no impact on local recurrence. Three and five-year survival rates were 84% and 49% respectively. Following LPM, the rate of local recurrence is low. This is influenced by the size of the metastatic nodules and completeness of the resection. Obtaining a safety margin of 5 mm seems to be sufficient, larger nodules require larger safety margins.
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Affiliation(s)
- Ahmad Shalabi
- Thoracic and Vascular Surgery Department, SLK Lung Medical Center Löwenstein, Löwenstein, Germany.
| | - Ahmed Ehab
- Pulmonary Medicine Department, SLK Lung Medical Center Löwenstein, Löwenstein, Germany
- Pulmonary Medicine Department, Mansoura University, Mansoura, Egypt
| | | | - Gudrun Kugler
- Thoracic and Vascular Surgery Department, SLK Lung Medical Center Löwenstein, Löwenstein, Germany
| | - H-J Schäfers
- Cardiovascular and Thoracic Surgery Department, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Graeter
- Thoracic and Vascular Surgery Department, SLK Lung Medical Center Löwenstein, Löwenstein, Germany
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Kanzaki R, Watari H, Omura A, Kawagishi S, Tanaka R, Maniwa T, Okami J. Outcomes and prognostic factors of repeat pulmonary metastasectomy. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae028. [PMID: 38426364 PMCID: PMC10927334 DOI: 10.1093/icvts/ivae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 02/27/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Information on prognostic factors after repeat pulmonary metastasectomy (PM) is limited, and outcomes after a third PM are not well documented. METHODS A single-institute retrospective study was conducted. Between 2000 and 2020, 68 patients underwent repeat PM for pulmonary metastases from various cancers. Outcomes and prognostic factors for the second PM and outcomes after the third PM were analysed. RESULTS This study included 39 men and 29 women. The mean age at second PM was 53.2 years old. The primary tumours were soft tissue sarcoma in 24 patients, colorectal cancer in 19 and osteosarcoma in 10. The interval between the first PM procedure and detection of pulmonary metastasis after the first PM (months) was ≤12 in 37 patients and >12 in 31 patients. At the second PM, 20 patients underwent lobectomy or bilobectomy, and 48 underwent sublobar resection. Complete resection was achieved in 60 patients, and 52 patients experienced recurrence after the second PM. The 5-year relapse-free survival and overall survival rates after the second PM were 27% and 48%, respectively. Multivariable analysis revealed that the interval between the first PM and the subsequent detection of pulmonary metastasis (≤12 months) was a poor prognostic factor for both relapse-free survival and overall survival after the second PM. Seventeen patients underwent a third PM, 3 of whom achieved a 3-year disease-free survival. CONCLUSIONS Patients with a period of >12 months between the first PM and the subsequent detection of pulmonary metastases showed favourable outcomes and are thus considered good candidates for second PM. A third PM may be beneficial for selected patients.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hirokazu Watari
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Akiisa Omura
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Sachi Kawagishi
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Ryo Tanaka
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tomohiro Maniwa
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
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10
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Miyashita Y, Ose N, Okami J, Takami K, Sakamaki Y, Ikeda N, Hayakawa M, Higashiyama M, Kodama K, Susaki Y, Funakoshi Y, Maeda J, Shintani Y. Outcomes of surgical resection for pulmonary metastasis from pancreatic cancer. Surg Today 2023; 53:1236-1246. [PMID: 37314516 PMCID: PMC10600288 DOI: 10.1007/s00595-023-02701-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/06/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE As the number of long-term survivors of pancreatic cancer is expected to increase thanks to recent advances in multidisciplinary treatment and earlier diagnoses of pancreatic cancer, we are likely to encounter more cases of postoperative pulmonary nodules. We analyzed the clinical course and prognosis of resection of pulmonary metastases from pancreatic cancer to clarify the prognostic implication of pulmonary metastasectomy for pancreatic cancer. METHOD We retrospectively analyzed 35 patients who underwent resection of lung metastases after pancreatic cancer surgery. Short- and long-term outcomes and factors associated with the prognosis were analyzed. RESULTS The observation period was 20 (range, 1-101) months, with 3- and 5-year survival rates of 88.3% and 64.5% from pancreatectomy and 44.1% and 28.3% from lung resection, respectively. A univariate analysis revealed that a period from pancreatic cancer resection to pulmonary nodule shadow detection of < 15 months was associated with a significantly lower overall survival from pancreatic resection than a longer period. Conversely, histological type, stage, size of lung metastases, and resection technique were not associated with the overall survival. CONCLUSION A long-term prognosis may be expected in some cases with a disease-free interval of ≥ 15 months. Our findings suggest that the disease-free interval may influence the prognosis.
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Affiliation(s)
- Yudai Miyashita
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Takami
- Department of Thoracic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasushi Sakamaki
- Department of Chest Surgery, Osaka Police Hospital, Osaka, Japan
| | - Naoki Ikeda
- Department of Thoracic Surgery, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Masanobu Hayakawa
- Department of Thoracic Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Osaka, Japan
| | - Masahiko Higashiyama
- Department of Thoracic Surgery, Higashi Osaka Medical Center, Higashiosaka, Osaka, Japan
| | - Ken Kodama
- Department of Thoracic Surgery, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Yoshiyuki Susaki
- Department of Thoracic Surgery, Ikeda City Hospital, Ikeda, Osaka, Japan
| | - Yasunobu Funakoshi
- Department of General Thoracic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Jun Maeda
- Department of Thoracic Surgery, Otemae Hospital, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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11
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Liu YW, Chou A, Chou SH. Experience of Simultaneous Bilateral Open Surgery and VATS for Pulmonary Metastasectomy. Thorac Cardiovasc Surg 2023; 71:121-129. [PMID: 35279816 DOI: 10.1055/s-0042-1744476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Resection is the current treatment of choice for resectable bilateral pulmonary metastases. This study aimed to compare the differences in outcomes between simultaneous bilateral open and video-assisted thoracic surgery (VATS) for pulmonary metastasectomy. METHODS Forty-three patients underwent pulmonary metastasectomy through one-stage bilateral open thoracotomy (n = 16) and VATS (n = 27) between 2011 and 2020. Perioperative and oncological data were analyzed. RESULTS The predominant primary tumor histology in both groups was colorectal cancer. The operative time, blood loss, and pain score on postoperative day 1 (POD1) were higher in the open group (p < 0.001, 0.009, and 0.03, respectively). No significant differences in pain score on POD2 and POD3, postoperative length of stay, or complications were found. Notably, numbers of the resected metastatic lung nodules were significantly greater in the open group (median number: 9.5 vs. 3, p < 0.001). Recurrence-free survival (RFS) and overall survival (OS) were comparable. The median RFS was 15 months (interquartile range [IQR], 6-22) in the open group and 18 months (IQR, 8-47) in the VATS group. The median OS was 28 months (IQR, 14-44) and 29 months (IQR, 15-54) in the open group and VATS group, respectively. CONCLUSION One-stage bilateral pulmonary metastasectomy is safe and reduces medical expenditures in selected patients regardless of surgical approach. Although the open group harbored a greater number of metastatic foci, perioperative and oncological outcomes were similar to that of the VATS group.
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Affiliation(s)
- Yu-Wei Liu
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Andre Chou
- Poznañ University of Medical Sciences, Poznañ, Poland
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Motas N, Davidescu MD, Tanase BC, Rus O, Burlacu AI, Alexe V, Manolache V, Mizea MC, Gheorghiu N, Trifanescu OG, Gales LN, Horvat T, Anghel RM. Oncologic Outcome after Pulmonary Metastasectomy as Part of Multidisciplinary Treatment in a Tertiary Oncological Center. Diagnostics (Basel) 2023; 13:diagnostics13010165. [PMID: 36611457 PMCID: PMC9818764 DOI: 10.3390/diagnostics13010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
(1) Background: Pulmonary metastases are encountered in approximately one-third of patients with malignancies, especially from colorectal, lung, breast, and renal cancers, and sarcomas. Pulmonary metastasectomy is the ablative approach of choice, when possible, as part of the multidisciplinary effort to integrate and personalize the oncological treatment. (2) Methods: The study includes 58 consecutive cases of pulmonary metastasectomies, retrospectively analyzed, performed in 12 consecutive months, in which the pathology reports confirmed lung metastases. (3) Results: Most frequent pathological types of metastases were: 14 of colorectal cancer, 10 breast, 8 lung, and 8 sarcomas. At the time of primary cancer diagnosis, 14 patients (24.14%) were in the metastatic stage. The surgical approach was minimally invasive through uniportal VATS (Video-Assisted Thoracic Surgery) in 3/4 of cases (43 patients, 74%). Almost 20% of resections were typical (lobectomy, segmentectomy). Lymphadenectomy was associated in almost 1/2 of patients and lymph node metastases were found in 11.11% of cases. The mortality rate (intraoperative and 90 days postoperative) is zero. The OS after pulmonary metastasectomy is 87% at 18 months, and the estimated OS for cancer is 90% at 5 years. The worst outcome presents the patients with sarcomas and the best outcome-colorectal and lung cancer. The patients with 1 or 2 resected metastases presented 96% survival at 24 months. (4) Conclusions: After pulmonary metastasectomy, survival is favored by the small number of metastases resected (1 or 2), and by the dimension of metastases under 20.5 mm. The non-anatomic (wedge) type of lung resection may present a lower risk of death compared to lobectomy. No statistical significance on survival has the presence of lymphadenectomy, the laterality right/left lung, the upper/lower lobes. In the future, longer follow-up and prospective randomized trials are needed for drawing definitive conclusions.
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Affiliation(s)
- Natalia Motas
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
- Correspondence: (N.M.); (M.D.D.)
| | - Mihnea Dan Davidescu
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
- Correspondence: (N.M.); (M.D.D.)
| | - Bogdan Cosmin Tanase
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Ovidiu Rus
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Alin Ionut Burlacu
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Vlad Alexe
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Veronica Manolache
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, Memorial Oncology Hospital, Șoseaua Gheorghe Ionescu Sisești 8a, 013812 Bucharest, Romania
| | - Madalina Cristiana Mizea
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Nicolae Gheorghiu
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Oana Gabriela Trifanescu
- Clinic of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Laurentia Nicoleta Gales
- Clinic of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Teodor Horvat
- Clinic of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
| | - Rodica Maricela Anghel
- Clinic of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology Bucharest, 022328 Bucharest, Romania
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13
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Patients with Pulmonary Metastases from Head and Neck Cancer Benefit from Pulmonary Metastasectomy, A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081000. [PMID: 35893115 PMCID: PMC9332790 DOI: 10.3390/medicina58081000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The incidence of distant metastases in patients with head and neck cancer (HNC) is approximately 10%. Pulmonary metastases are the most frequent distant location, with an incidence of 70-85%. The standard treatment options are chemo-, immuno- and radiotherapy. Despite a benefit for long-term survival for patients with isolated pulmonary metastases, pulmonary metastasectomy (PM) is not the treatment of choice. Furthermore, many otorhinolaryngologists are not sufficiently familiar with the concept of PM. This work reviews the recent studies of pulmonary metastatic HNC and the results after pulmonary metastasectomy. Materials and Methods: PubMed, Medline, Embase, and the Cochrane library were checked for the case series' of patients undergoing metastasectomy with pulmonary metastases published since 1 January 2000. Results: We included the data of 15 studies of patients undergoing PM. The 5-year survival rates varied from 21% to 59%, with median survival from 10 to 77 months after PM. We could not identify one specific prognostic factor for long-term survival after surgery. However, at least most studies stated that PM should be planned if a complete (R0) resection is possible. Conclusions: PM showed reliable results and is supposedly the treatment of choice for patients with isolated pulmonary metastases. Patients not suitable for surgery may benefit from other non-surgical therapy. Every HNC patient with pulmonary metastases should be discussed in the multidisciplinary tumor board to optimize the therapy and the outcome.
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14
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Mangiameli G, Cioffi U, Alloisio M, Testori A. Lung Metastases: Current Surgical Indications and New Perspectives. Front Surg 2022; 9:884915. [PMID: 35574534 PMCID: PMC9098997 DOI: 10.3389/fsurg.2022.884915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Pulmonary metastasectomy is an established treatment that can provide improved long- term survival for patients with metastatic tumor(s) in the lung. In this mini-review, we discuss the state of the art of thoracic surgery in surgical management of lung metastases which actually occurs for a large part of surgical activity in thoracic surgery department. We describe the principles of surgical therapy that have been defined across the time, and that should remain the milestones of lung metastases treatment: a radical surgery and an adequate lymphadenectomy. We then focus on current surgical indications and report the oncological results according to the surgical approach (open vs. mini-invasive), the histological type and number of lung metastases, and in case of re-metastasectomy. Finally, we conclude with a brief overview about the future perspectives in thoracic surgery in treatment of lung metastases.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
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15
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Chiappetta M, Salvatore L, Congedo MT, Bensi M, De Luca V, Petracca Ciavarella L, Camarda F, Evangelista J, Valentini V, Tortora G, Margaritora S, Lococo F. Management of single pulmonary metastases from colorectal cancer: State of the art. World J Gastrointest Oncol 2022; 14:820-832. [PMID: 35582100 PMCID: PMC9048528 DOI: 10.4251/wjgo.v14.i4.820] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common causes of death from cancer. Lung seeding occurs in approximately 10% of patients surgically treated for primary CRC with radical intent: the lung is the most common site of metastases after the liver. While surgical treatment of liver metastases is widely accepted to affect long-term outcomes, more controversial and not standardized is the therapy for CRC patients developing lung metastases. Experience suggests the potential curative role of pulmonary metastasectomy, especially in oligometastatic disease. However, the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined. This review focused on the uncommon scenario of single pulmonary metastases from CRC. We explored pertinent literature and provide an overview of the epidemiology, clinical characteristics and imaging of single pulmonary metastases from CRC. Additionally, we identified the best available evidence for overall management. In particular, we analyzed the role and results of locoregional approaches (surgery, radiotherapy or ablative procedures) and their integration with systemic therapy.
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Affiliation(s)
- Marco Chiappetta
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Lisa Salvatore
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Bensi
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Viola De Luca
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Leonardo Petracca Ciavarella
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Floriana Camarda
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Jessica Evangelista
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Vincenzo Valentini
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giampaolo Tortora
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
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16
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6529440. [DOI: 10.1093/ejcts/ezac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
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17
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Forster C, Ojanguren A, Perentes JY, Zellweger M, Krueger T, Abdelnour-Berchtold E, Gonzalez M. Survival prognostic and recurrence risk factors after single pulmonary metastasectomy. J Cardiothorac Surg 2021; 16:357. [PMID: 34961544 PMCID: PMC8713404 DOI: 10.1186/s13019-021-01740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Identification of the prognostic factors of recurrence and survival after single pulmonary metastasectomy (PM). Methods Retrospective analysis of all consecutive patients who underwent PM for a single lung metastasis between 2003 and 2018. Results A total of 162 patients with a median age of 64 years underwent single PM. Video-Assisted Thoracic Surgery (VATS) was performed in 83.9% of cases. Surgical resection was achieved by wedge in 73.5%, segmentectomy in 7.4%, lobectomy in 17.9% and pneumonectomy in 1.2% of cases. The median durations of hospital stay and of drainage were 4 days (IQR 3–7) and 1 day (IQR 1–2), respectively. During the follow-up (median 31 months; IQR 15–58), 93 patients (57.4%) presented recurrences and repeated PM could be realized in 35 patients (21.6%) achieved by VATS in 77.1%. Non-colorectal tumour (HR 1.84), age < 70 years (HR 1.77) and previous extra-thoracic metastases (HR 1.61) were identified as prognostic factors of recurrence. Overall survival at 5-year was estimated at 67%. Non-colorectal tumour (HR 2.40) and mediastinal lymph nodes involvement (HR 3.42) were significantly associated with an increased risk of death. Conclusions Despite high recurrence rates after PM, surgical resection shows low morbidity rate and acceptable long-term survival, thus should remain the standard treatment for single pulmonary metastases. Trial registration: The Local Ethics Committee approved the study (No. 2019–02,474) and individual consent was waived.
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Affiliation(s)
- Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Etienne Abdelnour-Berchtold
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland.
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18
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Eriguchi T, Tsukamoto N, Kumabe A, Ogata T, Inoue Y, Sugawara A. Suitability of Metastatic Lung Tumors for Stereotactic Body Radiotherapy. Cancer Invest 2021; 40:378-386. [PMID: 34894945 DOI: 10.1080/07357907.2021.2017950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We investigated factors influencing local control of lung metastases treated with stereotactic body radiotherapy (SBRT) and determined the type of lesions for which SBRT is more suitable. Ninety-six patients and 196 tumors were included. Median follow-up duration was 32.0 months (range 4.7-95.8). The two-year local recurrence rate was 15.2% (95% confidence interval: 10.2-21.3). Multivariate analysis revealed biological effective dose, ultracentral tumor location, reirradiation, and prior chemotherapy as significant factors. SBRT is suitable for lung metastases, especially for peripheral tumors and those located in the inner lung parenchyma. For ultracentral lesions and recurrent lesions after SBRT, metastasectomy is recommended.
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Affiliation(s)
- Takahisa Eriguchi
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.,Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.,Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Nobuhiro Tsukamoto
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Atsuhiro Kumabe
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Takeru Ogata
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yoshimasa Inoue
- Department of Thoracic Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Akitomo Sugawara
- Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Japan
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19
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Ma Y, Zhang Y, Li H, Li J, Chen H, Wang P, Xiao R, Li X, Wang S, Qiu M. Spread through air spaces is a common phenomenon of pulmonary metastasized tumours regardless of origins. Eur J Cardiothorac Surg 2021; 61:1242-1248. [PMID: 34894137 DOI: 10.1093/ejcts/ezab530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/24/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Spread through air spaces (STAS) is a unique pattern of invasion in primary lung cancers. However, little is known about STAS in pulmonary metastases (PMs). This study was to investigate the incidence of STAS among PMs and the association between STAS and clinicopathological characteristics of PMs. METHODS A total of 127 patients who underwent metastasectomy at our institution from June 2009 to December 2019 were retrospectively analysed. Survival analysis was performed in 40 patients with PM from colorectal cancer (CRC). RESULTS STAS was identified in 33.1% of patients (42 of 127) with PMs. STAS was found in PMs of various primary cancers, including CRC, breast cancer, renal cell carcinoma, cholangiocarcinoma and osteogenic and soft tissue sarcoma, but the incidence varies. PMs originating from epithelial tissue showed higher incidence of STAS than those from mesenchymal tissue (45% vs 11%, P < 0.001). Elder age (P = 0.006) and primary sites (P < 0.001) were significantly correlated with STAS. In patients with PMs from CRC, the presence of STAS was an independent predictor of shorter recurrence-free survival (hazard ratio = 10.25, P = 0.002) and poor overall survival (hazard ratio = 4.75, P = 0.047) by multivariable analysis. CONCLUSIONS STAS might be a lung-specific tumour invasion pattern and STAS is commonly observed in PMs of different origins. The incidence of STAS was significantly higher in PMs originating from epithelial tissues than those from mesenchymal tissues. Presence of STAS was an independent predictor of poor prognosis in patients with PM from CRC.
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Affiliation(s)
- Yi Ma
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Zhang
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Haoran Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Jiawei Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Haiming Chen
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Peiyu Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Rongxin Xiao
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Shaodong Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Mantang Qiu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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20
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Yamaguchi H, Sato M, Yamamoto K, Ueda K, Date H, Chen-Yoshikawa T, Yamada Y, Tokuno J, Yanagiya M, Kojima F, Yoshiyasu N, Kobayashi M, Nakashima Y, Koike T, Sakamoto J, Kosaka S, Fukai R, Nishida T, Sakai H, Shinohara S, Takenaka M, Tanaka F, Misawa K, Nakajima J. Virtual-assisted lung mapping in sublobar resection of small pulmonary nodules, long-term results. Eur J Cardiothorac Surg 2021; 61:761-768. [PMID: 34662398 DOI: 10.1093/ejcts/ezab421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/03/2021] [Accepted: 08/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The short-term efficacy of virtual-assisted lung mapping (VAL-MAP), a preoperative bronchoscopic multi-spot lung-marking technique, has been confirmed in 2 prospective multicentre studies. The objectives of this study were to analyse the local recurrence and survival of patients enrolled in these studies, long-term. METHODS Of the 663 patients enrolled in the 2 studies, 559 patients' follow-up data were collected. After excluding those who did not undergo VAL-MAP, whose resection was not for curative intent, who underwent concurrent resection without VAL-MAP, or who eventually underwent lobectomy instead of sublobar resection (i.e. wedge resection or segmentectomy), 422 patients were further analysed. RESULTS Among 264 patients with primary lung cancer, the 5-year local recurrence-free rate was 98.4%, and the 5-year overall survival (OS) rate was 94.5%. Limited to stage IA2 or less (≤2 cm in diameter; n = 238, 90.1%), the 5-year local recurrence-free and OS rates were 98.7% and 94.8%, respectively. Among 102 patients with metastatic lung tumours, the 5-year local recurrence-free rate was 93.8% and the 5-year OS rate was 81.8%. Limited to the most common (colorectal) cancer (n = 53), the 5-year local recurrence-free and OS rates were 94.9% and 82.3%, respectively. CONCLUSIONS VAL-MAP, which is beneficial in localizing small barely palpable pulmonary lesions and determining the appropriate resection lines, was associated with reasonable long-term outcomes. SUBJ COLLECTION 152, 1542.
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Affiliation(s)
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Keiko Ueda
- Clinical Research Support Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | | | - Yoshito Yamada
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Junko Tokuno
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Masahiro Yanagiya
- Department of General Thoracic Surgery, NTT Medical Center, Tokyo, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Nobuyuki Yoshiyasu
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan.,Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Masashi Kobayashi
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Nakashima
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jin Sakamoto
- Department of Thoracic Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shinji Kosaka
- Department of Thoracic Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Ryuta Fukai
- Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tomoki Nishida
- Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroaki Sakai
- Department of Thoracic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Shinji Shinohara
- The Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Takenaka
- The Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumihiro Tanaka
- The Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kenji Misawa
- Department of Thoracic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
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21
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He H, Chen P, Chen X, Wang PY, Liu SY, Wang F. Analysis of anatomical variations of the lingular artery of the left upper lobe using 3D computed tomography angiography and bronchography. J Thorac Dis 2021; 13:5035-5041. [PMID: 34527341 PMCID: PMC8411136 DOI: 10.21037/jtd-21-1141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/11/2021] [Indexed: 11/06/2022]
Abstract
Background Thoracic surgeons must be familiar with the anatomy of the pulmonary artery during segmentectomy and segmentectomy. But pulmonary arteries have numerous variations and aberrant branching patterns. The purpose of the present study was to analyze the anatomical variations and frequencies of the lingular artery of the left upper lobe (LUL) using 3D computed tomography angiography and bronchography (3D-CTAB). Methods We retrospectively studied 166 patients having undergone lobectomy or segmentectomy from January to December 2020 at Fujian Medical University Cancer Hospital's Department of Thoracic Surgery. All patients underwent 3D reconstruction using 3D-CTAB before surgery. Results The lingular segment was supplied by 1 artery in 45.18% of cases, 2 arteries in 46.39% of cases, and 3 arteries in 8.43% of cases. The branching patterns of the lingular artery included 119 (71.68%) cases with interlobar origin, 35 (21.08%) cases with interlobar and mediastinal origin, and 13 (7.83%) cases with mediastinal origin. The interlobar lingular artery include superior lingular artery (A4) and inferior lingular artery (A5). The interlobar lingular artery type was A4a, A4b, A5 in 7.23% of cases; A4 and A4b+5 in 3.01% of cases; and A4b and A4a+5 in 4.82% of cases. The mediastinal lingular artery was divided into the following 5 types: 'A4', 'A4b', 'A4b+5', 'A4b+5a', and 'A4+5'. The most common type was A4 (12.05%, 20/166) in 166 patients. The interlobar lingular artery had the following 5 patterns of variation: 'A4+5', 'A4, A5', 'A4a, A4b, A5', 'A4a, A4b+5', and 'A4b, A4a+5'. The single interlobar lingular artery (A4+5) was the most common type in 38.55% of cases. In 24.10% of cases, A5 came from A8 or A8+9. Besides In 8.43% of cases, the origin of A5 was close to A8 or A8+9. Conclusions We identified the left various lingular artery branching patterns with 3D-CTAB in patients and defined the frequency of anatomic variations. 3D-CTAB is useful for finding these variations.
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Affiliation(s)
- Hao He
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Peng Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Xiaofeng Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Pei Yuan Wang
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Shuo Yan Liu
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Feng Wang
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
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22
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Beckers P, Berzenji L, Yogeswaran SK, Lauwers P, Bilotta G, Shkarpa N, Hendriks J, Van Schil PE. Pulmonary metastasectomy in colorectal carcinoma. J Thorac Dis 2021; 13:2628-2635. [PMID: 34012611 PMCID: PMC8107514 DOI: 10.21037/jtd-2019-pm-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide. It is estimated that 50% of all patients with CRC develop metastases, most commonly in the liver and the lung. Lung metastases are seen in approximately 10–15% of all patients with CRC. A large number of these patients with metastatic CRC can only receive palliative treatment due to invasion of other organs and disseminated disease. However, a subset of these patients present with potentially resectable metastases. Pulmonary metastasectomy is considered to be a potentially curative treatment for selected patients with resectable metastatic CRC. Current data suggest that patients that undergo pulmonary metastasectomy have 5-year survival rates of approximately 40%. However, the majority of data published regarding lung metastasectomy is based on small, retrospective case series. Due to this lack of prospective data, it is still unclear which subset of patients will benefit most from curative-intent surgery. Furthermore, there is also controversy regarding which prognostic and genetic factors are related to survival outcomes and whether there is a difference between open and thoracoscopic approaches in terms of overall and disease-free survival. In this review, we aim to summarize the latest data on prognostic factors and survival outcomes after pulmonary metastasectomy in patients with metastatic CRC.
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Affiliation(s)
- Paul Beckers
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Lawek Berzenji
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Suresh K Yogeswaran
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Giada Bilotta
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Nikol Shkarpa
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Jeroen Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
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23
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Kanzaki R, Fukui E, Kanou T, Ose N, Funaki S, Minami M, Shintani Y, Okumura M. Preoperative evaluation and indications for pulmonary metastasectomy. J Thorac Dis 2021; 13:2590-2602. [PMID: 34012607 PMCID: PMC8107542 DOI: 10.21037/jtd-19-3791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary metastasectomy (PM) is an established treatment that can provide improved long-term survival for patients with metastatic tumor(s) in the lung. In the current era, where treatment options other than PM such as stereotactic body radiation therapy (SBRT), immunotherapy, and molecular-targeted therapy are available, thoracic surgeons should review the approach to the preoperative evaluation and the indications. Preoperative evaluation consists of history and physical examinations, physiological tests, and radiological examinations. Radiological examinations serve to identify the differential diagnosis of the pulmonary nodules, evaluate their precise number, location, and features, and search for extra thoracic metastases. The indication of PM should be considered from both physiological and oncological points of view. The general criteria for PM are as follows; (I) the patient has a good general condition, (II) the primary malignancy is controlled, (III) there is no other extrapulmonary metastases, and (IV) the pulmonary lesion(s) are thought to be completely resectable. In addition to the general eligibility criteria of PM, prognostic factors of each tumor type should be considered when deciding the indication for PM. When patients have multiple poor prognostic factors and/or a short disease-free interval (DFI), thoracic surgeons should not hesitate to observe the patient for a certain period before deciding on the indication for PM. A multidisciplinary discussion is needed in order to decide the indication for PM.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Eriko Fukui
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Japan
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24
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Forster C, Ojanguren A, Perentes JY, Zellweger M, Federici S, Krueger T, Abdelnour-Berchtold E, Gonzalez M. Is repeated pulmonary metastasectomy justified? Clin Exp Metastasis 2020; 37:675-682. [PMID: 32920725 PMCID: PMC7665970 DOI: 10.1007/s10585-020-10056-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 02/07/2023]
Abstract
Recurrence after pulmonary metastasectomy (PM) is frequent, but it is unclear to whom repeated pulmonary metastasectomy (RPM) offers highest benefits. Retrospective analysis of oncological and post-operative outcomes of consecutive patients who underwent PM from 2003 to 2018. Overall survival (OS) and disease-free interval (DFI) were calculated. Cox regression was used to identify variables influencing OS and DFI. In total, 264 patients (female/male: 114/150; median age: 62 years) underwent PM for colorectal cancer (32%), sarcoma (19%), melanoma (16%) and other primary tumors (33%). Pulmonary metastasectomy was approached by video-assisted thoracic surgery (VATS) in 73% and pulmonary resection was realized by non-anatomical resection in 76% of cases. The overall median follow-up time was 33 months (IQR 16–56 months) and overall 5-year survival rate was 62%. Local or distant recurrences were observed in 172 patients (65%) and RPM could be performed in 66 patients (25%) for a total of 116 procedures. RPM was realized by VATS in 49% and pulmonary resection by wedge in 77% of cases. In RPM patients, the 5-year survival rate after first PM was 79%. Post-operative cardio-pulmonary complication rate (13% vs. 12%; p = 0.8) and median length of stay (4 vs. 5 days; p = 0.2) were not statistically different between first PM and RPM. Colorectal cancer (HR 0.56), metachronous metastasis (HR 0.48) and RPM (HR 0.5) were associated with better survival. In conclusion, our results suggest that RPM offers favorable survival rates without increasing post-operative morbidity.
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Affiliation(s)
- Céline Forster
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Amaya Ojanguren
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Matthieu Zellweger
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sara Federici
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Thorsten Krueger
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | | | - Michel Gonzalez
- Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland.
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25
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Lautz TB, Farooqui Z, Jenkins T, Heaton TE, Doski JJ, Cooke-Barber J, Murphy AJ, Davidoff AM, Mansfield SA, Kim ES, Zuber S, Goodhue C, Vasudevan SA, LaQuaglia MP, Piche N, Le-Nguyen A, Aldrink JH, Malek MM, Siow VS, Glick RD, Rich BS, Meyers RL, Short SS, Butter A, Baertschiger RM, Fialkowski EA, Dasgupta R. Thoracoscopy vs thoracotomy for the management of metastatic osteosarcoma: A Pediatric Surgical Oncology Research Collaborative Study. Int J Cancer 2020; 148:1164-1171. [PMID: 32818304 DOI: 10.1002/ijc.33264] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 01/01/2023]
Abstract
Complete surgical resection of pulmonary metastatic disease in patients with osteosarcoma is crucial to long-term survival. Open thoracotomy allows palpation of nodules not identified on imaging but the impact on survival is unknown. The objective of this study was to compare overall survival (OS) and pulmonary disease-free survival (DFS) in children who underwent thoracotomy vs thoracoscopic surgery for pulmonary metastasectomy. A multi-institutional collaborative group retrospectively reviewed 202 pediatric patients with osteosarcoma who underwent pulmonary metastasectomy by thoracotomy (n = 154) or thoracoscopy (n = 48). Results were analyzed by Kaplan-Meier survival estimates and multivariate Cox proportional hazard regression models. With median follow-up of 45 months, 135 (67.5%) patients had a pulmonary relapse and 95 (47%) patients were deceased. Kaplan-Meier analysis showed no significant difference in 5-year pulmonary DFS (25% vs 38%; P = .18) or OS (49% vs 42%, P = .37) between the surgical approaches of thoracotomy and thoracoscopy. In Cox regression analysis controlling for other factors impacting outcome, there was a significantly increased risk of mortality (HR 2.11; P = .027; 95% CI 1.09-4.09) but not pulmonary recurrence (HR 0.96; P = .90; 95% CI 0.52-1.79) with a thoracoscopic approach. However, in the subset analysis limited to patients with oligometastatic disease, thoracoscopy had no increased risk of mortality (HR 1.16; P = .62; 0.64-2.11). In conclusion, patients with metastatic osteosarcoma and limited pulmonary disease burden demonstrate comparable outcomes after thoracotomy and thoracoscopy for metastasectomy. While significant selection bias in these surgical cohorts limits the generalizability of the conclusions, clinical equipoise for a randomized clinical trial in patients with oligometastatic disease is supported.
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Affiliation(s)
- Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Zishaan Farooqui
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Todd Jenkins
- Departments of Pediatrics and Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Todd E Heaton
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John J Doski
- Division of Pediatric Surgery, UT San Antonio, San Antonio, Texas, USA
| | - Jo Cooke-Barber
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Andrew J Murphy
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sara A Mansfield
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Eugene S Kim
- Division of Pediatric Surgery, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Samuel Zuber
- Division of Pediatric Surgery, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Catherine Goodhue
- Division of Pediatric Surgery, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Michael P LaQuaglia
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nelson Piche
- Division of Pediatric Surgery, CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Annie Le-Nguyen
- Division of Pediatric Surgery, CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vei Shaun Siow
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York, USA
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York, USA
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Scott S Short
- Division of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Andreana Butter
- Division of Pediatric Surgery, Children's Hospital of Western Ontario, London, Ontario, Canada
| | - Reto M Baertschiger
- Division of Pediatric Surgery, Department of Surgery, NH, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Division of Thoracic and General Surgery, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - Elizabeth A Fialkowski
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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26
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Kawagishi S, Kanzaki R, Taniguchi S, Kimura K, Kimura T, Takabatake H, Morii E, Inoue M, Shintani Y. A case of repeat resection for recurrent pulmonary metastasis from sebaceous gland carcinoma. Surg Case Rep 2020; 6:206. [PMID: 32785813 PMCID: PMC7423815 DOI: 10.1186/s40792-020-00947-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/20/2020] [Indexed: 01/23/2023] Open
Abstract
Background Sebaceous gland carcinoma (SGC) of the eyelid is an aggressive malignant eyelid tumor, and it can metastasize to the regional lymph nodes and distant organs. There have been only a few reported cases of patients who underwent pulmonary metastasectomy for metastatic SGC. We herein report a patient who underwent repeat pulmonary metastasectomies for recurrent pulmonary metastases from SGC. Case presentation Bilateral small pulmonary nodules were detected in a 59-year-old woman with a history of eyelid SGC. She underwent wide wedge resection of the left lower lobe, and the disease was diagnosed as pulmonary metastases from SGC. Six months after the first pulmonary resection, CT showed that the nodules of right S2 and S10 had increased in size, and three small nodules had newly appeared in the right lung. The patient therefore underwent six wide wedge resections of the right lung through thoracotomy. After that, she underwent pulmonary metastasectomy 2 times. Ninety months after the first pulmonary resection, the patient is doing well without disease. Conclusions Given that a long-term survival was ultimately achieved in the present case, repeat pulmonary metastasectomy may be beneficial for recurrent pulmonary metastasis from SGC.
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Affiliation(s)
- Sachi Kawagishi
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, 565-0871, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, 565-0871, Japan.
| | - Seiji Taniguchi
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, 565-0871, Japan
| | - Kenji Kimura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, 565-0871, Japan
| | - Toru Kimura
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | | | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, 565-0871, Japan
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27
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Kanzaki R, Okami J, Takami K, Iwasaki T, Ikeda N, Funakoshi Y, Sakamaki Y, Kodama K, Yokouchi H, Kadota Y, Ose N, Shintani Y. Outcomes of surgical resection for pulmonary metastasis from ovarian cancer. J Cardiothorac Surg 2020; 15:182. [PMID: 32703262 PMCID: PMC7379766 DOI: 10.1186/s13019-020-01231-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background Due to its rarity, information on pulmonary metastasectomy for pulmonary metastasis from ovarian cancer is limited. Methods Cases of pulmonary metastasectomy for ovarian cancer were collected in a multi-institutional setting and the outcomes were analyzed. Results Among 1508 cases in which pulmonary resection was performed to treat pulmonary metastasis from tumors of various organs, 6 cases (0.4%) involved pulmonary metastasis from ovarian cancer. The mean age was 61 years (range, 39–75 years). The histological types were undifferentiated carcinoma in 2 patients, and clear cell adenocarcinoma, serous papillary cystadenocarcinoma, serous adenocarcinoma, and endometroid adenocarcinoma in 1 patient each. One patient (17%) had a history of liver metastasis at the time of pulmonary resection. The median disease-free interval was 22 months (range, 0 [synchronous]-188 months). The tumor was solitary in 5 patients (83%). The mean tumor size was 15 mm (range, 5–23 mm). All 6 patients underwent complete resection. The type of resection was wide wedge resection in 3 patients, segmentectomy in 2 patients, and lobectomy in 1 patient. Four patients (67%) received postoperative chemotherapy. Thus far, 4 patients (67%) have experienced recurrence after pulmonary resection. In terms of outcomes, 1 patient who had synchronous pulmonary metastasis with the primary tumor died in the early period after pulmonary resection, 1 patient is alive without recurrence after a short follow-up period (5 months), 3 patients have achieved mid- to long-term survival and are alive with disease (38–61 months), and 1 patient achieved long-term (61 months) disease-free survival. Conclusions Patients with pulmonary metastasis from ovarian cancer who fulfill the eligibility criteria for pulmonary metastasectomy are rare. Pulmonary metastasectomy for ovarian cancer can provide favorable outcomes in highly selected patients. Patients with synchronous pulmonary metastasis from ovarian cancer are not good candidates for pulmonary metastasectomy.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, 565-0871, Japan.
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Takami
- Department of Thoracic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Teruo Iwasaki
- Department of General Thoracic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Naoki Ikeda
- Department of Thoracic Surgery, Sakai City Medical Center, Sakai, Japan
| | - Yasunobu Funakoshi
- Department of Thoracic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yasushi Sakamaki
- Department of Thoracic Surgery, Osaka Police Hospital, Osaka, Japan
| | - Ken Kodama
- Department of Thoracic Surgery, Yao Municipal Hospital, Yao, Japan
| | - Hideoki Yokouchi
- Department of Thoracic Surgery, Suita Municipal Hospital, Suita, Japan
| | - Yoshihisa Kadota
- Department of Thoracic Surgery, Osaka Habikino Medical Center, Habikino, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, 565-0871, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, 565-0871, Japan
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28
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Phillips JD, Porter ED, Beaulieu-Jones BR, Fay KA, Hasson RM, Millington TM, Finley DJ. Postoperative atrial fibrillation prophylaxis using a novel amiodarone order set. J Thorac Dis 2020; 12:3110-3124. [PMID: 32642233 PMCID: PMC7330745 DOI: 10.21037/jtd-20-180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Studies have demonstrated that chemoprophylaxis following anatomic lung resection can reduce post-operative atrial fibrillation (POAF). However, it is unclear if non-anatomic wedge resection warrants prophylaxis, as previously published rates vary widely. The primary goal of this study was to assess an institutional rate of POAF following anatomic resections with implementation of a novel amiodarone administration regimen compared to wedge resections without prophylaxis. Methods We performed a retrospective cohort study of a prospectively maintained database and compared anatomic and wedge lung resection patients from 1/2015 to 4/2018. During the study period, a previously unpublished amiodarone order set consisting of a 300 mg IV bolus followed by 400 mg tablets TID ×3 days was administered to anatomic resection patients ≥65 who met criteria. Wedge resection patients were not intended to receive amiodarone prophylaxis. The primary outcome was POAF incidence. Risk factors for developing POAF were assessed. Results A total of 537 patients met inclusion where 56% underwent anatomic resection and 44% wedge resection. Overall, 5.4% of patients experienced POAF. There was a significant reduction in post-anatomic resection POAF as compared to historic rates without prophylaxis (9.3% vs. 20.3%, P<0.001). A single wedge resection patient (0.4%) developed POAF. On multivariable analysis, the only independent POAF risk factor was age ≥65 (OR: 5.41, 95% CI: 1.47-19.85). Conclusions Administration of our novel amiodarone order set reduces POAF after anatomic resection; however, POAF following wedge resection is too rare to warrant chemoprophylaxis.
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Affiliation(s)
- Joseph D Phillips
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Eleah D Porter
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
| | | | - Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
| | - Rian M Hasson
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Timothy M Millington
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - David J Finley
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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29
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Kanzaki R, Susaki Y, Takami K, Funakoshi Y, Sakamaki Y, Kodama K, Yokouchi H, Ikeda N, Kadota Y, Iwasaki T, Ose N, Shintani Y. Long-Term Outcomes of Pulmonary Metastasectomy for Uterine Malignancies: A Multi-institutional Study in the Current Era. Ann Surg Oncol 2020; 27:3821-3828. [PMID: 32274663 PMCID: PMC7471138 DOI: 10.1245/s10434-020-08426-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Information on pulmonary metastasectomy (PM) for uterine malignancies in the current era is limited. In the present study, we analyzed the clinical course and results of PM for uterine malignancies in the era of modern imaging diagnostics to clarify the role of PM in the current era in a multi-institutional setting. METHODS Fifty-seven patients who underwent PM for uterine malignancies between 2006 and 2015 were retrospectively reviewed. The short- and long-term outcomes, along with factors associated with the prognosis, were analyzed. Details of the clinical course after PM were described. RESULTS The mean age of patients was 59.4 years. The primary tumor was located in the uterus corpus in 34 cases (60%) and in the uterus cervix in 23 cases (40%). The median disease-free interval (DFI) was 32 months. Forty patients (70%) received fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography before PM, and complete resection was achieved in 52 patients (91%). Postoperative complications occurred in 4 patients (7%). Of the 52 patients who underwent complete resection of pulmonary metastases, 28 experienced recurrence, and among these, 17 (60%) underwent local therapy, including six repeat PMs. Among the 52 patients who underwent complete resection, the 5-year relapse-free survival rate was 40.7% and the 5-year overall survival (OS) rate was 68.8%. The univariate analysis revealed that a DFI of ≤ 24 months was associated with significantly poorer OS. CONCLUSIONS PM for uterine malignancies is safe and provides favorable long-term outcomes in selected patients. Patients with a DFI of > 24 months have better OS and are good candidates for PM.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan.
| | - Yoshiyuki Susaki
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Takami
- Department of Thoracic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasunobu Funakoshi
- Department of Thoracic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yasushi Sakamaki
- Department of Thoracic Surgery, Osaka Police Hospital, Osaka, Japan
| | - Ken Kodama
- Department of Thoracic Surgery, Yao Municipal Hospital, Yao, Japan
| | - Hideoki Yokouchi
- Department of Thoracic Surgery, Suita Municipal Hospital, Suita, Japan
| | - Naoki Ikeda
- Department of Thoracic Surgery, Sakai City Medical Center, Sakai, Japan
| | - Yoshihisa Kadota
- Department of Thoracic Surgery, Osaka Habikino Medical Center, Habikino, Japan
| | - Teruo Iwasaki
- Department of Thoracic Surgery, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
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Kanzaki R, Suzuki O, Kanou T, Ose N, Funaki S, Shintani Y, Minami M, Tamari K, Otani K, Seo Y, Isohashi F, Ogawa K, Okumura M. The short-term outcomes of pulmonary metastasectomy or stereotactic body radiation therapy for pulmonary metastasis from epithelial tumors. J Cardiothorac Surg 2020; 15:43. [PMID: 32103767 PMCID: PMC7045582 DOI: 10.1186/s13019-020-1079-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Stereotactic body radiation therapy (SBRT) has recently been widely performed for relatively small-volume tumors. We analyzed the short-term outcomes of pulmonary metastasectomy (PM) or SBRT for pulmonary metastases. Methods This study was a retrospective analysis of 82 patients with pulmonary metastasis from epithelial tumors who underwent PM or SBRT between 2013 and 2016. Results Fifty-nine patients underwent PM, 21 patients underwent SBRT, and 2 patients underwent combined PM and SBRT. The mean age of the PM group was significantly lower than that of the SBRT group (60.6 vs 67.4 years, p = 0.03). The most frequent types of primary tumor in the PM and SBRT groups were colorectal cancer (n = 27, 46%) and head and neck squamous cell carcinoma (n = 8, 38%), respectively. The rate of treatment-associated complications did not differ between the two groups to a statistically significant extent (20% vs 24%, p = 0.76). The 3-year local control rates of the two groups were similar (PM group, 88%; SBRT group, 92%; p = 0.48). The 3-year progression-free survival (PFS) rate of the PM group were better than that of SBRT groups (42% vs 11%, p = 0.01). The 3-year overall survival (OS) rates of the PM and SBRT groups were 77 and 52% respectively; although the rate of the PM group was higher, the difference was not statistically significant (p = 0.10). Conclusions SBRT provides a favorable 3-year local control rate. The 3-year OS rate of the SBRT group tended to be lower than that of the PM group, despite the difference was not statistically significant. PM and SBRT play complementary roles in patients with pulmonary metastases.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan. .,Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Japan.
| | - Osamu Suzuki
- Department of Radiation Therapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Keisuke Tamari
- Department of Radiation Therapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keisuke Otani
- Department of Radiation Therapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuji Seo
- Department of Radiation Therapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Fumiaki Isohashi
- Department of Radiation Therapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Therapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan.,Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Japan
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Lung metastasectomy after colorectal cancer: prognostic impact of resection margin on long term survival, a retrospective cohort study. Int J Colorectal Dis 2020; 35:9-18. [PMID: 31686201 DOI: 10.1007/s00384-019-03386-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pulmonary metastasectomy is considered a potentially curative treatment for selected patients with metastatic colorectal cancer (CRC). Several prognostic factors have been analysed, but to date, it is still not well defined which is the optimal resection margin during lung metastasectomy (LM). This study analyses the long-term results and prognostic factors after LM in CRC patients with particular attention to the resection margins. Primary endpoint of this study is to assess the correlation between resection margins and long-term outcomes. METHODS Observational cohort study on all proven cases of CRC lung metastases (2000-2016) resected with curative intent in a single centre. RESULTS The series included 210 consecutive patients (M/F 133/77) with a mean age of 65.4 (± 9.96) years, 75% (159/210) of them with a solitary metastasis. Mean size of metastasis was 2.57 cm (± 1.45). One hundred sixty-eight patients underwent wedge resections (80%) and lymphadenectomy was carried out in 90 cases (42.9%). With a mean follow-up of 56 months (range 5-192), we observed a 1-, 3- and 5-year overall survival (OS) of 95%, 74% and 54%, respectively. The patients were divided into three groups according to the resection margin distance from the tumour: (a) ≥ 2 cm (145 cases); (b) < 2, ≥ 1 cm (37 cases); and (c) < 1 cm (12 cases). The OS was significantly different between the three groups (p = 0,020); univariate and multivariate analyses showed that a narrow resection margin was an independent prognostic factor of worse survival (p = 0.006 and HR 3.4 p = 0.009). CONCLUSIONS Long-term survival of patients after LM is strongly associated with a greater distance between the lesion and the resection margin.
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Patella M, Bartolucci DA, Mongelli F, Cartolari R, Minerva EM, Inderbitzi R, Cafarotti S. Spiral wire localization of lung nodules: procedure effectiveness and oncological usefulness. J Thorac Dis 2019; 11:5237-5246. [PMID: 32030241 DOI: 10.21037/jtd.2019.11.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background In the last years, a large number of techniques and devices for localizing small pulmonary nodules prior to resection have been developed with the aim of facilitating minimally invasive surgery (VATS). However, each device presents pros and cons and there is no unanimous consensus. We report our experience with an uncommon wire system with spiral shape for percutaneous marking. Methods We recorded 102 consecutive CT-guided spiral wire localizations in our Institution, and we evaluated the efficacy of the method according to 4 success rates (SR): (I) successful targeting rate (SR-1): number of successful targeting procedures/number of all localizations; (II) successful localization in operative field (SR-2): (number of successful targeting procedures -number of dislodgements in operative field)/number of all localizations; (III) successful VATS rate (SR-3): number of successful VATS procedures/(number of localizations-number of thoracotomies not due to wire dislocation); (IV) successful curative rate (SR-4): number of neoplastic nodules resected with curative intent with free margins (R0) on definitive tissue diagnosis/number of neoplastic nodules resected with curative intent. Complications rate was recorded as well. Results SR-1: 100%, SR-2: 97.1%, SR-3: 100%, SR-4: 100%. Asymptomatic pneumothorax and minimal parenchymal hemorrhage were observed in 5 (4.9%) and 19 (18.6%) cases, respectively. Conclusions Spiral wire localization showed very good results in terms of feasibility, stability in operative field and contributed to effective use of VATS during wedge resection performed for malignant nodules. In the era of widespread radiological investigations (as it is happening in lung cancer screening) and evolutions in cancer treatments, this appears to be clinically relevant.
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Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | | | - Francesco Mongelli
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Roberto Cartolari
- Service of Radiology, San Giovanni Hospital, Bellinzona, Switzerland
| | | | - Rolf Inderbitzi
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
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Kanzaki R, Kanou T, Ose N, Funaki S, Minami M, Tajima T, Fujii M, Ohno Y, Shintani Y. Proposal of a Useful Surrogate Endpoint of the Overall Survival in Patients Undergoing Pulmonary Metastasectomy: The Time to Local Therapy Failure. World J Surg 2019; 43:2640-2646. [PMID: 31243525 DOI: 10.1007/s00268-019-05071-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A recent study demonstrated remarkable discrepancy between the relapse-free survival (RFS) and overall survival (OS) after pulmonary metastasectomy (PM) in the current era. As the RFS may not be a suitable parameter after PM, a more suitable parameter is needed for PM as a surrogate marker for OS. METHODS A total of 134 consecutive patients who underwent PM were retrospectively analyzed. In the present study, we introduced a new endpoint, time to local treatment failure (TLTF). This endpoint was defined as the time interval between the first PM and the first untreatable recurrence by local treatment with curative intent or death due to any cause. We analyzed the correlation between the RFS and OS and between the TLTF and OS to validate whether or not the TLTF is a better parameter than the RFS after PM. RESULTS Thus far, 78 patients have experienced relapse. Of these, 37 patients (47%) underwent local therapy with curative intent, 29 of whom are alive without local treatment failure. The 5-year OS, RFS and TLTF were 70.9%, 36.5%, and 57.6%, respectively. The concordance proportions for the RFS and OS and for the TLTF and OS were 0.634 and 0.851 for all patients, respectively. The Spearman's rank correlation coefficient for the RFS and OS was 0.639, while that for the TLTF and OS was 0.875. CONCLUSIONS The TLTF may be a good surrogate parameter for the OS after PM in the current era.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Testuya Tajima
- Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Fujii
- Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuko Ohno
- Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Metastatic Cardiac Hemangiosarcoma in a 6 Year Old Wheaten Terrier Mix. Vet Sci 2019; 6:vetsci6030065. [PMID: 31340545 PMCID: PMC6789882 DOI: 10.3390/vetsci6030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/18/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022] Open
Abstract
A 6 year old Wheaten Terrier mix with a history of collapse and lethargy was referred for evaluation of pericardial effusion. The echocardiogram identified pericardial effusion and a right auricular mass. No sign of metastasis was noted at this time in thoracic radiographs and abdominal ultrasounds. The patient underwent the right auriculectomy via right lateral thoracotomy. Several metastatic masses were located in the visceral aspect of the pericardium at the time of surgery and were all excised. The right auricular mass and pericardial masses were diagnosed as hemangiosarcoma with a sign of metastasis. The patient recovered from surgery uneventfully and was discharged the sixth day after surgery. The patient received doxorubicin followed by cyclophosphamide, piroxicam and Coriolus versicolor extract postoperatively. Pulmonary metastases were noted 229 days and the dog was euthanized 318 days after surgery. No clinical signs were noted until 309 days postoperatively.
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Chung JH, Lee SH, Yi E, Lim JY, Jung JS, Son HS, Sun K. Impact of resection margin length and tumor depth on the local recurrence after thoracoscopic pulmonary wedge resection of a single colorectal metastasis. J Thorac Dis 2019; 11:1879-1887. [PMID: 31285880 DOI: 10.21037/jtd.2019.05.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background To evaluate the influence of tumor depth on preoperative computed tomography (CT) image, and resection margin length on local recurrence after pulmonary metastasectomy of colorectal cancer. Methods Patients undergoing thoracoscopic pulmonary wedge resection for single pulmonary metastasis of colorectal cancer origin from 2007 to 2017 were analyzed. Factors such as resection margin, tumor size and depth were analyzed. The local recurrences of two subgroups based on the pulmonary resection margin (Group 1: resection margin 1-10 mm or shorter than the tumor size, Group 2: resection margin >10 mm or at least greater than the tumor size) were analyzed. Results Sixty-five patients were included in this study. The local recurrence rate was 12/65 (18.5%). Median follow up period was 33 months. Median tumor size and depth on preoperative CT were 1.1 and 1.6 cm. Median length of resection margin was 0.5 cm (group 1: 0.4 cm, group 2: 1.0 cm, P<0.001). No difference was noted in 3-year local recurrence-free survival (80.8% vs. 76.7%, P=0.756) between the two subgroups. No significant correlation was noted between the length of resection margin and the tumor size and depth. However, tumor depth was an independent factor related to higher local recurrence on multivariate analysis. Conclusions Extent of resection margin in pulmonary metastasectomy does not seem to affect significantly on the local recurrence if complete resection is accomplished. However, preoperative tumor depth on CT image and postoperative distant metastasis seem to affect on local recurrence after pulmonary metastasectomy.
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Affiliation(s)
- Jae Ho Chung
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Sung Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Eunjue Yi
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Ju Yong Lim
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Ho Sung Son
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Kyung Sun
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
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Kawakita N, Takizawa H, Sawada T, Matsumoto D, Tsuboi M, Toba H, Yoshida M, Kawakami Y, Kondo K, Tangoku A. Indocyanine green fluorescence imaging for resection of pulmonary metastasis of hepatocellular carcinoma. J Thorac Dis 2019; 11:944-949. [PMID: 31019784 DOI: 10.21037/jtd.2019.01.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Indocyanine green (ICG) accumulates in hepatocellular carcinoma (HCC), and tumor fluorescence can be observed under irradiation with near infrared light (NIR). This study investigated the clinical utility of ICG fluorescence imaging during resection of pulmonary metastases of HCC. Methods From April 2010 to June 2018, six patients with suspected pulmonary metastasis of HCC were enrolled prospectively. Prior to surgery, all patients underwent the ICG hepatic function test following intravenous administration of ICG (0.5 mg/kg body weight). During surgery, metastatic HCC was identified by observation of ICG fluorescence, allowing assessment of the surgical margin. Tumor fluorescence was also evaluated on cut sections. Results A total of 11 metastatic HCCs were resected in six patients at nine operations. Eight lesions were removed by wedge resection and 3 lesions were managed by lobectomy. During surgery, tumor fluorescence could be confirmed through the visceral pleura in 6 out of 7 lesions treated by wedge resection, while NIR irradiation was difficult for 1 lesion. For these 6 lesions, the median distance from the tumor to the visceral pleura and the median surgical margin were 0 mm (range, 0-2 mm) and 14 mm (range, 11-17 mm), respectively. When cut sections were examined, all tumors emitted fluorescence. All lesions were histologically confirmed to be metastatic HCC. Conclusions In patients with pulmonary metastasis of HCC, ICG fluorescence imaging is useful for identifying the tumor and securing its margin when the lesion is peripheral and wedge resection is planned.
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Affiliation(s)
- Naoya Kawakita
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toru Sawada
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Daisuke Matsumoto
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Mitsuhiro Tsuboi
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiroaki Toba
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Mitsuteru Yoshida
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yukikiyo Kawakami
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kazuya Kondo
- Department of Oncological Medical Services, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Akira Tangoku
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Phillips JD, Hasson RM. Surgical management of colorectal lung metastases. J Surg Oncol 2019; 119:629-635. [PMID: 30811031 DOI: 10.1002/jso.25425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/05/2019] [Accepted: 02/10/2019] [Indexed: 12/17/2022]
Abstract
Pulmonary metastasectomy for colorectal cancer is an established means of treatment for select patients. This article will highlight the recent evidence published in the literature related to current practices for the surgical management of colorectal lung metastases and propose a diagnostic algorithm for use in clinical practice. It will also discuss controversies related to pulmonary metastasectomy, including the optimal timing of surgery, the extent of lymph node sampling/dissection, and the extent of surgical resection.
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Affiliation(s)
- Joseph D Phillips
- Department of Surgery, Dartmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Rian M Hasson
- Department of Surgery, Dartmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Yamamoto Y, Kanzaki R, Kanou T, Ose N, Funaki S, Shintani Y, Minami M, Outani H, Takenaka S, Hamada K, Yoshikawa H, Okumura M. Long-term outcomes and prognostic factors of pulmonary metastasectomy for osteosarcoma and soft tissue sarcoma. Int J Clin Oncol 2019; 24:863-870. [DOI: 10.1007/s10147-019-01422-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
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Nelson DB, Tayob N, Mitchell KG, Correa AM, Hofstetter WL, Sepesi B, Walsh GL, Vaporciyan AA, Swisher SG, Antonoff MB, Roth JA, Rice DC, Vauthey JN, Mehran RJ. Surgical margins and risk of local recurrence after wedge resection of colorectal pulmonary metastases. J Thorac Cardiovasc Surg 2018; 157:1648-1655. [PMID: 30635188 DOI: 10.1016/j.jtcvs.2018.10.156] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/09/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE During resection of pulmonary metastases, the need to spare lung parenchyma is often weighed against the increased risk of local recurrence if an inadequate surgical margin is obtained. We sought to identify risk factors for local recurrence after wedge resection of pulmonary metastases of a colorectal origin. METHODS A retrospective study of patients who underwent a wedge resection for colorectal pulmonary metastases from 2006 to 2016 was performed. Cox regression with robust variance was used to estimate the risk of local recurrence per nodule treated. RESULTS We identified 335 patients who underwent 679 wedge resections. The 2-year local recurrence risk for each nodule was 11.8% (95% confidence interval, 8.9%-14.6%), and the 5-year risk was 20.6% (95% confidence interval, 16.2%-24.8%). Longer margin length decreased the risk of local recurrence (hazard ratio, 0.434 per additional cm of length; P = .015), whereas larger tumor size increased this risk (hazard ratio, 1.520 per additional cm of size; P = .012). However, other factors tested, including tumor grade, KRAS mutation status, and response to induction chemotherapy, did not affect recurrence risk. A pathologic margin length of at least half the tumor size was estimated to result in a local recurrence rate <11%. CONCLUSIONS Among surgically resected colorectal pulmonary metastases, technical factors related to margin length and tumor size were associated with the risk of local recurrence, whereas tumor grade and KRAS status were not. However, the increased risk of local recurrence with larger tumors was diminished with a sufficient margin length.
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Affiliation(s)
- David B Nelson
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Nabihah Tayob
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
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Sato M, Kobayashi M, Kojima F, Tanaka F, Yanagiya M, Kosaka S, Fukai R, Nakajima J. Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection. J Thorac Cardiovasc Surg 2018; 156:1691-1701.e5. [DOI: 10.1016/j.jtcvs.2018.05.122] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/25/2018] [Accepted: 05/11/2018] [Indexed: 11/25/2022]
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Gorospe-Sarasúa L, Eugenia-Rioja M, Ajuria-Illarramendi O, Cabañero-Sánchez A. Percutaneous Marking of 2Adjacent Pulmonary Metastases With a Single Equidistant Seed. Arch Bronconeumol 2018; 55:50-51. [PMID: 29803526 DOI: 10.1016/j.arbres.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/29/2018] [Accepted: 04/05/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Luis Gorospe-Sarasúa
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - María Eugenia-Rioja
- Servicio de Medicina Nuclear, Hospital Universitario Ramón y Cajal, Madrid, España
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Dohopolski MJ, Horne Z, Clump D, Burton SA, Heron DE. Stereotactic Body Radiation Therapy for Pulmonary Oligometastases Arising from Non-lung Primaries in Patients Without Extrapulmonary Disease. Cureus 2018; 10:e2167. [PMID: 29644155 PMCID: PMC5889151 DOI: 10.7759/cureus.2167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) is increasingly used in the management of patients with oligometastatic cancers and is under prospective evaluation by the Radiation Therapy Oncology Group (RTOG). Here we report outcomes from a high-volume institution of patients treated with SBRT for pulmonary oligometastases. Materials and methods We conducted a retrospective review of 105 patients who had one to five pulmonary oligometastases (185 lesions) without extrapulmonary disease treated with SBRT from 2002-2014. Target failure-free survival (TFFS), progression-free survival (PFS), and overall survival (OS) were calculated. Univariate and multivariate Cox regression analyses were performed on factors predictive of outcomes. Results The median age at first SBRT was 68 years and the median follow-up was 29.5 months. The median time from initial diagnosis of primary to SBRT was 42.7 months; 14.3% had synchronous oligometastases and 76.7% had one to two pulmonary lesions at first SBRT. The distribution of primaries was as follows: 36.2% colorectal, 16.2% head/neck, 9.5% genitourinary, 9.5% sarcoma, 7.6% gynecologic, 6.7% other, 5.7% breast, 5% melanoma, and 4% esophageal. The median lesion size was 1.6 cm and the most common regimen was 60 Gy in three fractions (range: 12-60 Gy in one to five fractions). TFFS was 94.4% and 90.8% at two and three years, respectively. Two and three year OS were 87.9% and 60.2%, respectively. Median PFS and OS were 16.2 and 45.3 months, respectively. In multivariate analysis, age at primary cancer diagnosis and biologically effective dose with an alpha-beta ratio of 10 (BED10) were identified as factors significantly affecting OS (p<0.05). Conclusions Comprehensive treatment of pulmonary oligometastases with SBRT in the absence of extrapulmonary disease results in excellent target control and modest survival outcomes.
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Affiliation(s)
| | - Zachary Horne
- Department of Radiation Oncology, UPMC Hillman Cancer Center
| | - David Clump
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, UPMC
| | - Steven A Burton
- Department of Radiation Oncology, UPMC Hillman Cancer Center
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, UPMC
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Nakazawa S, Shimizu K, Mogi A, Kuwano H. VATS segmentectomy: past, present, and future. Gen Thorac Cardiovasc Surg 2017; 66:81-90. [PMID: 29255967 DOI: 10.1007/s11748-017-0878-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has gradually been implemented in thoracic surgery, and the VATS approach has now been extended to technically challenging procedures, such as segmentectomy. The definition of VATS segmentectomy is changing over time, and the repertoire of segmentectomy is getting wider with increasing reports on atypical segmentectomy. VATS segmentectomy bears surgical, oncological, and technical advantages; however, there are still areas of controversy, particularly regarding oncological outcomes. The indication of VATS segmentectomy is diverse and is used for treating lung cancer, metastatic lung tumors, or a variety of nonmalignant diseases. It is particularly valuable for the lung-sparing resection of deeply located small nodules or repeated surgery for multiple lung lesions. VATS segmentectomy requires a thorough analysis of segmental anatomy and a tailored preoperative planning with the assessment of surgical margins. Technical challenges include intraoperative navigation, methods to identify and dissect the intersegmental plane, and the prevention of air leakage. This review will discuss the present state of VATS segmentectomy, with a focus on past studies, current indications and techniques, and future view.
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Affiliation(s)
- Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroyuki Kuwano
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Shiono S, Okumura T, Boku N, Hishida T, Ohde Y, Sakao Y, Yoshiya K, Hyodo I, Mori K, Kondo H. Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg 2017; 51:504-510. [PMID: 27773868 DOI: 10.1093/ejcts/ezw322] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/10/2016] [Indexed: 01/01/2023] Open
Abstract
Objectives Although wedge resection is the most common surgical procedure for pulmonary metastases from colorectal cancer, there are few reports about segmentectomy for colorectal metastasectomy. Methods This was a subset analysis of a Japanese nationwide retrospective study of resected pulmonary metastases from colorectal cancer. The study included 553 patients who underwent segmentectomies ( n = 98) or wedge resections ( n = 455) without preoperative chemotherapy between January 2004 and December 2008. Recurrence patterns, recurrence-free survival and overall survival were analysed for each procedure. Results As for the patients' background factors, only the median size of resected metastases was different between patients with segmentectomies (median 18 mm, range 5-50 mm) and wedge resections (14 mm, 5-51 mm) ( P < 0.001). Prolonged air leak developed more frequently in those undergoing segmentectomy compared with wedge resection (5.1% vs 1.8%) ( P = 0.048). The resection-margin recurrence rate was higher in patients who underwent wedge resection compared with segmentectomy (7.3% vs 2.0%; P = 0.035). The 5-year recurrence-free survival was 48.8% in patients with segmentectomy and 36.0% in patients with wedge resections. The 5-year overall survival was 80.1% in patients with segmentectomy and 68.5% in patients with wedge resection. Multivariable analysis revealed that the surgical procedure, segmentectomy, was a significant favourable factor for recurrence (hazard ratio: 0.63, 95% confidence interval: 0.44-0.87, P = 0.005), but not for overall survival (hazard ratio: 0.65, 95% confidence interval: 0.38-1.05, P = 0.080). Conclusions Segmentectomy demonstrated a good efficacy with less resection-margin recurrence in patients with resectable pulmonary-limited metastasis from colorectal cancer.
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Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Takehiro Okumura
- Department of Surgery, School of Medicine, University Hospital Mizonokuchi, Teikyo University, Kanagawa, Japan
| | - Narikazu Boku
- Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyuki Hishida
- Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Katsuo Yoshiya
- Department of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Ichinosuke Hyodo
- Division of Gastroenterology Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Keita Mori
- Clinical Research Support Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruhiko Kondo
- General Thoracic Surgery, School of Medicine, Kyorin University, Tokyo, Japan
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Kanzaki R, Kimura T, Kawamura T, Funaki S, Shintani Y, Minami M, Yamasaki M, Mori M, Doki Y, Okumura M. Surgery for malignant pulmonary nodules in patients with a history of oesophageal cancer. Interact Cardiovasc Thorac Surg 2017; 24:418-424. [PMID: 28040757 DOI: 10.1093/icvts/ivw358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/19/2016] [Indexed: 01/16/2023] Open
Abstract
Objectives The objective of this study is to analyse the short- and long-term results of surgery for malignant pulmonary nodules in patients with a history of oesophageal cancer (EC) in order to assess the significance of surgery in these patients. Methods The data of 28 consecutive patients with a history of EC who underwent pulmonary resection for malignant pulmonary nodules were reviewed. The perioperative and long-term results were analysed. Results The histological type of oesophageal cancer was squamous cell carcinoma in all of the patients. The preceding treatments for EC were surgery with or without neoadjuvant therapy in 21, chemoradiotherapy in 4 and endoscopic resection in 3. The patients were smokers, with low body mass indices, and had high incidences of a history of malignancy besides EC and other comorbidities. Complete resection was achieved in 27 patients (96%). There was no perioperative mortality and 7 patients (25%) developed postoperative complications. Based on the pathological and clinical criteria, 14 patients (50%) were diagnosed with primary lung cancer, 10 patients (35%) with pulmonary metastases from EC and 4 patients (25%) with pulmonary metastasis from another cancer. The 5-year disease-free and overall survival rates of all patients were 48% and 60%, respectively. Conclusions Surgery for malignant pulmonary nodules in patients with a history of EC can be performed with acceptable surgical risk despite the high rate of comorbid illness in these patients. Proactive surgical management should be considered for treating malignant pulmonary nodules in patients with a previous history of EC as this strategy provides favourable long-term results.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toru Kimura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomohiro Kawamura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Kanzaki R, Inoue M, Kimura T, Kawamura T, Funaki S, Shintani Y, Minami M, Takemasa I, Mizushima T, Mori M, Okumura M. Role of pulmonary metastasectomy in colorectal cancer in the era of modern multidisciplinary therapy. Surg Today 2017; 47:1111-1118. [PMID: 28205021 DOI: 10.1007/s00595-017-1478-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/11/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To clarify the role of pulmonary metastasectomy in colorectal cancer in the era of modern multidisciplinary therapy. METHODS The characteristics and outcomes of the patients who underwent pulmonary metastasectomy for colorectal cancer through 2002 (n = 26) and from 2003 (n = 68) were compared. RESULTS The patients treated from 2003 had a smaller tumor size and more frequently had a history of extra-pulmonary relapses than did those treated through 2002. There was a significant improvement in the 5-year overall survival (42.0% vs. 73.1%, p = 0.03) but not the 5-year relapse-free survival (41.4% vs. 37.5%, p = 0.85) after pulmonary metastasectomy from 2003. The rate of patients who received local therapy with curative intent after the first pulmonary metastasectomy was significantly higher in patients treated from 2003 than in those treated through 2002 [4/13, (31%) vs. 25/39 (64%), p = 0.04]. The survival after relapse after the first pulmonary metastasectomy was significantly longer in patients treated from 2003 than in those treated through 2002 (median survival time: 14 vs. 47 months). CONCLUSIONS Pulmonary metastasectomy for colorectal cancer remains an important treatment option in the sense that it can achieve a good relapse-free survival.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan.
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toru Kimura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Tomohiro Kawamura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan
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Franzke K, Natanov R, Zinne N, Rajab TK, Biancosino C, Zander I, Lodziewski S, Ricklefs M, Kropivnitskaya I, Schmitto JD, Haverich A, Krüger M. Pulmonary metastasectomy - A retrospective comparison of surgical outcomes after laser-assisted and conventional resection. Eur J Surg Oncol 2016; 43:1357-1364. [PMID: 27771210 DOI: 10.1016/j.ejso.2016.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/01/2016] [Accepted: 09/02/2016] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Indications and surgical techniques for pulmonary metastasectomy (PME) are controversially discussed issues. Laser-assisted surgery (LAS) is a recent innovation that has been advocated especially in patients with multiple pulmonary metastases (PM). However, there are hardly any studies comparing surgical outcomes after laser-assisted and conventional resection. The aim of the current study was to evaluate the value of LAS in a larger study population. MATERIALS & METHODS A retrospective analysis was completed on 178 consecutive patients undergoing 236 PMEs at a single center between 2010 and 2015. The main endpoint was survival. Statistical analysis was performed using the Kaplan-Meier method and survival rates were compared with the log rank test. Follow-up was done with special attention to the development of recurrent PM. Local relapse was defined as a recurrent metastasis in direct relation to the previously resected area according to CT scan comparisons. RESULTS LAS was performed on 256 metastases in 99 patients, non-laser-assisted surgery (NLAS) on 127 metastases in 79 patients. 5-year-survival rates were 69.3% in all patients, 65.7% after LAS and 73.6% after NLAS. There was no statistically significant survival difference after LAS or NLAS (p = 0.41). The rate of local relapse was 0.8% after LAS vs 3.1% after NLAS (p = 0.073). CONCLUSION Despite a larger number of negative predictors for survival in LAS patients, overall survival (OS) was similar in the compared groups. There was also a trend for a lower risk of local relapses after LAS. Therefore, LAS should be considered a promising method for PME.
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Affiliation(s)
- K Franzke
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - R Natanov
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - N Zinne
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - T K Rajab
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - C Biancosino
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - I Zander
- Centre for Oncology, Rundestraße 10, Hannover, Germany
| | - S Lodziewski
- Centre for Internal Medicine, DIAKOVERE Friederikenstift, Hannover, Germany
| | - M Ricklefs
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - I Kropivnitskaya
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - J D Schmitto
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - A Haverich
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - M Krüger
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; Department of Thoracic Surgery, Martha-Maria Hospital, Halle-Dölau, Germany
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Abstract
Most patients with pulmonary metastases will not be candidates for pulmonary metastasectomy. Preoperative evaluation determines whether a patient is both fit enough for surgery and has disease that is actually resectable. Both components are necessary for patients who undergo resection with curative intent. In general, to be considered for pulmonary metastasectomy, patients must fit the following criteria: the primary disease site and any extrathoracic disease are both controlled; complete resection of pulmonary involvement is achievable with adequate pulmonary reserve; and there are no effective medical therapies.
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Shiono S, Yanagawa N. Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stage I lung adenocarcinoma. Interact Cardiovasc Thorac Surg 2016; 23:567-72. [PMID: 27354463 DOI: 10.1093/icvts/ivw211] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/25/2016] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Spread through air spaces (STAS) is considered a prognosticator related to local recurrence. We assessed the prognostic impact of spread through air spaces and local recurrence in stage I lung adenocarcinoma. METHODS From July 2004 to November 2014, 877 lung cancer patients underwent surgery, of whom 318 with pathological stage I adenocarcinoma were reviewed. We investigated the characteristics of spread through air spaces and analysed the relationship between spread through air spaces and prognosis. RESULTS The median follow-up was 30 months. Of the 318 patients, 47 (14.8%) had spread through air spaces. The patients with spread through air spaces were associated with male sex (P < 0.001), smoking (P < 0.001), solid nodules (P < 0.001), stage IB disease (P = 0.006), epidermal growth factor receptor mutation negativity (P < 0.001), and lymphovascular (P < 0.001) and pleural invasion (P = 0.001). Among the preoperative findings, spread through air spaces was significantly related to solid nodules on computed tomography. Local recurrence occurred in 11 of 47 (23.4%) cases with spread through air spaces and 10 of 271 (3.7%) cases without spread through air spaces (P < 0.01). Univariate analysis showed that the overall 5-year survival rates were 62.7 and 91.1% in cases with and without spread through air spaces, respectively (P < 0.01), and the recurrence-free 5-year survival rates were 54.4 and 87.8% in cases with and without spread through air spaces, respectively (P < 0.01). Multivariate analysis confirmed spread through air spaces as a significant prognosticator for overall survival and a predictive factor for recurrence after surgery. CONCLUSIONS Among stage I lung adenocarcinoma patients, spread through air spaces was found frequently in the invasive cases and was closely related to poor prognosis and recurrence.
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Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Naoki Yanagawa
- Department of Pathology, Yamagata Prefectural Central Hospital, Yamagata, Japan
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Pagès PB, Serayssol C, Brioude G, Falcoz PE, Brouchet L, Le Pimpec-Barthes F, Thomas PA, Bernard A. Risk factors for survival and recurrence after lung metastasectomy. J Surg Res 2016; 203:293-300. [DOI: 10.1016/j.jss.2016.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 12/27/2022]
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