• Lymphadenectomy
• Nephrectomy
• Oligometastatic renal cell carcinoma
• Pulmonary metastasectomy
• Stereotactic ablative radiation
• Systemic therapy
• Video-assisted thoracoscopic surgery

• Humans
• Carcinoma, Renal Cell/secondary
• Carcinoma, Renal Cell/surgery
• Kidney Neoplasms/pathology
• Metastasectomy/methods
• Lung Neoplasms/secondary
• Lung Neoplasms/surgery
• Pneumonectomy/methods

• Metastasectomy
• Metastasis directed therapy
• Metastatic kidney cancer
• Renal cell carcinoma

• Humans
• Retrospective Studies
• Carcinoma, Renal Cell/therapy
• Carcinoma, Renal Cell/pathology
• Carcinoma, Renal Cell/secondary
• Carcinoma, Renal Cell/mortality
• Male
• Kidney Neoplasms/pathology
• Kidney Neoplasms/therapy
• Kidney Neoplasms/mortality
• Female
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/therapy
• Neoplasm Recurrence, Local/mortality
• Neoplasm Recurrence, Local/drug therapy
• Middle Aged
• Aged
• Survival Rate
• Follow-Up Studies
• Prognosis
• Nephrectomy/mortality

• lung metastasis
• metastasectomy
• nonprimary lung cancer
• pulmonary metastasis
• secondary lung cancer

• The authors received no specific funding for this work.

• Immunotherapy
• immune check-point inhibitors
• metastasectomy
• oligometastasis
• surgical resection

• Carcinoma, Renal Cell/therapy
• Humans
• Kidney Neoplasms/pathology
• Metastasectomy/adverse effects
• Metastasectomy/methods
• Nephrectomy
• Retrospective Studies
• Treatment Outcome

• Metastatic kidney cancer
• metastasectomy
• metastatic renal cell carcinoma
• renal cancer
• renal cell carcinoma

• P30 CA072720 NCI NIH HHS
• grant from the National Cancer Institute

• percutaneous ablation
• pulmonary metastatic disease
• stereotactic body radiotherapy
• surgery

• Ablation Techniques/adverse effects
• Ablation Techniques/mortality
• Humans
• Lung Neoplasms/mortality
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/secondary
• Lung Neoplasms/surgery
• Metastasectomy/adverse effects
• Metastasectomy/mortality
• Pneumonectomy/adverse effects
• Pneumonectomy/mortality
• Radiosurgery/adverse effects
• Radiosurgery/mortality
• Risk Assessment
• Risk Factors
• Treatment Outcome

Identification of the prognostic factors of recurrence and survival after single pulmonary metastasectomy (PM).

Retrospective analysis of all consecutive patients who underwent PM for a single lung metastasis between 2003 and 2018.

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.

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.

• Pulmonary metastasectomy
• Pulmonary metastases
• VATS

• Carcinoma, Renal Cell/surgery
• Humans
• Kidney Neoplasms/surgery
• Metastasectomy
• Retrospective Studies
• Treatment Outcome

• Long-term remission
• Metastasectomy
• Neoplasm metastasis
• Nephrectomy
• Systemic treatment

This multicentric paper aimed at evaluating the role of pulmonary metastasectomy in patients affected by metastatic renal cell carcinoma. The impact of pulmonary metastasectomy was analysed with respect to long-term survival and disease-free survival in a wide population of patients affected by pulmonary metastases from renal cell carcinoma. The prognostic value of factors affecting survival, disease-free interval and disease-free survival was evaluated. Our results aid clinicians in identifying those patients affected by pulmonary metastases from renal cell carcinoma who are more likely to benefit from pulmonary metastasectomy.

In this paper we aimed to address the role of pulmonary metastasectomy (PM) in patients affected by Lung Metastases (LM) from Renal Cell Carcinoma (RCC) and to analyse prognostic factors affecting overall survival (OS), disease-free interval (DFI) between primary RCC and first LM, and disease-free survival (DFS) after PM and before lung recurrence. Medical records of 210 patients who underwent PM from RCC in 4 Italian Thoracic Centres, from January 2000 to September 2019, were collected and analysed. All patients underwent RCC resection before lung surgery. The main RCC histology was clear cells (188, 89.5%). The 5- and 10-year OS from the first lung operation were 60% and 34%, respectively. LM synchronous with RCC (p = 0.01) and (Karnofsky Performance Status Scale) KPSS < 80% (p < 0.001) negatively influenced OS. Five- and 10-year DFI were 54% and 28%, respectively. The main factors negatively influencing DFI were: male gender (p = 0.039), KPSS < 80% (p = 0.009) and lactate dehydrogenase > 1.5 times 140 U/L (p = 0.001). Five- and 10-year disease-free survival were 54% and 28%, respectively; multiple LM (p = 0.036), KPSS < 80% (p = 0.001) and histology of RCC other than clear cells negatively influenced disease-free survival. Conclusions: patients with KPSS > 80%, single metachronous LM with a long DFI from RCC diagnosis, and clear cell histology, benefit from pulmonary metastasectomy.

• lung metastases
• metastasectomy
• metastatic renal cell carcinoma
• renal cell carcinoma

Renal cell carcinoma represents approximately 3% of all cancers, with the highest incidence occurring in the western world. Around 33% of the patients experience metastatic disease at diagnosis. Since the approval of the first targeted therapy, the treatment of metastatic renal cell carcinoma (mRCC) has positively changed, but the surgical treatment of the primary tumor, and metastases if possible, is sometimes crucial in selected patients controlling the burden of cancer sites with the intention to improve survival. We, herein, report on a case of a young male patient presented in the emergency room with gross hematuria which underwent transdiaphragmatic nephrectomy with synchronous pulmonary and anterior thoracic wall mass metastasectomy with a single thoracic incision due to mRCC. Achieving a full response in patients with mRCC is extremely rare only with medical treatment. The role of complete surgical metastasectomy is questioned, but there are several studies that support its efficacy in achieving metastases free status prolonged overall survival and better quality of life. The therapeutic treatment plan for these patients should be discussed within dedicated multidisciplinary cancer centers and focus on each patient individually and they should be offered a closed follow-up strategy.

• Metastasectomy
• metastatic renal carcinoma
• nephrectomy
• transdiaphragmatic

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.

• Pulmonary metastasectomy (PM)
• indication
• prognostic factor
• radiological examinations

Renal cell carcinoma (RCC) remains a public health issue and seems to be increasing. A significant proportion of RCC patients will develop pulmonary metastasis at some point in their evolution. In this review, we aimed to update the surgical management of pulmonary metastases as well as systemic therapy, including targeted therapies, according to recent data in the literature. We retrospectively reviewed studies evaluating the benefit of pulmonary metastasectomy in RCC patients and evaluating the place of different chemotherapies, targeted therapies and immunotherapies through November 1, 2019. Several retrospective studies have shown the benefit of pulmonary metastasectomy in metastatic RCC (mRCC), most in a situation with only pulmonary metastases. According to the prognostic criteria of the IMDC risk model, the patient is classified into a prognostic group to identify the best systemic treatment. With the development of targeted therapies, the modalities are multiple and may involve tyrosine kinase inhibitors/checkpoint inhibitors and soon vaccine therapy or CAR-T cells. At the local level, in patients who cannot benefit from surgery, stereotactic radiotherapy or radiofrequency has a place to be considered. Although there is a lack of a randomized study, pulmonary metastasectomy appears to be feasible and effective. The place and modalities of systemic therapies in the era of targeted therapies remain to be more clearly defined.

• Renal cell carcinoma (RCC)
• lung
• metastasis

•

A submillimeter metastatic lung tumor was resected successfully by intraoperative marking using a mobile CT with a navigation system.

Preoperative localization of non-palpable lung nodules plays an important role in video assisted thoracic surgery (VATS). Although percutaneous computed tomography (CT)-guided hook wire marking has become widely accepted, it is accompanied by rare but fatal complications such as air embolisms. We herein report a case of a submillimeter pulmonary nodule successfully localized by a mobile CT scan with a navigation system.

A 40-year-old-man presented with the two right pulmonary nodules 4 years after a radical left nephrectomy for a renal clear cell carcinoma. One of the nodules was too small to palpate and preoperative marking was applied using a mobile CT scan with a navigation system. We successfully performed VATS wedge resection for both nodules and confirmed a pathological diagnosis of a metastasis from the renal cell carcinoma. The maximum pathological size of the smaller nodule was 500 μm.

Preoperative marking of the lower lobe lesion in the present case was essential for VATS. Our novel technique was helpful for the precise marking without any morbidity.

Preoperative marking using a mobile CT scan with a navigation system is safe and easily applicable. It might be a useful option for VATS of non-palpable lung nodules.

• Case report
• Image-guided video assisted thoracic surgery (iVATS)
• Mobile computed tomography
• Navigation system
• Non-palpable lung nodule
• Preoperative marking

• Case report
• Metastases
• Radiation
• Renal cell carcinoma
• Surgery
• Systemic therapy
• Thermal ablation

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.

• Pulmonary metastasectomy
• Pulmonary metastases
• Repeat metastasectomy
• VATS

• Metastasectomy
• Renal cell carcinoma
• Salvage

• Immune checkpoint inhibitors
• Immunotherapy
• Metastasectomy
• Metastatic renal cell carcinoma
• Prognostic factors
• Radiation
• Targeted therapy
• Thermal ablation

• Lymph node metastases
• Surgery
• Target
• Treatment planning
• Tumor heterogeneity

• Long-term survival
• Lymph node metastases
• Metastasectomy
• Oncological staging
• Preoperative diagnostics

This study evaluated the effects of metastasectomy on overall survival (OS) and progression-free survival (PFS) in metastatic renal cell carcinoma (mRCC) according to metastatic organs. The medical records (2005–2017) of 273 patients with mRCC were analyzed retrospectively to evaluate OS and PFS according to metastatic organs and their metastasectomy states. The Cox proportional hazard model was used to determine the prognostic significance of metastasectomy. The Kaplan-Meier curve and log-rank test were used to compare groups with different modalities and metastatic organs at a statistical significance of p < 0.05. The overall median age was 57 years; 175 (64.3%) and 83 (30.4%) patients received cytoreductive nephrectomy and metastasectomy, respectively. The metastasectomy group was significantly younger and had a lower clinical T stage with significantly better PFS/OS (20.2/32.0 vs. 9.7/12.8 months) than that in the non-metastasectomy group (N = 190, p < 0.05). Liver with lung metastases were the worst metastatic combination for survivals in which liver metastasis was the only significant unfavorable risk factor for both PFS (HR 1.67) and OS (HR 1.74) (p < 0.05). Multivariable analysis confirmed that metastasectomy was a significant favorable risk factor for PFS (HR 0.70) and OS (HR 0.56) (p < 0.05) along with non-clear cell type (HR 0.61 for PFS), whereas the nuclear grade and poor Heng risk group were unfavorable risk factors (HR > 2.0) for both PFS and OS (p < 0.05). Metastasectomy and the affected metastatic organs significantly influenced prognostic survival in mRCC.

• metastasectomy
• metastasis
• organs
• renal cell carcinoma
• survival

• Lombardy
• Oligometastatic cancer
• Radiotherapy
• Stereotactic body radiotherapy
• Survey

• Metastasectomy
• Metastases
• Renal cell carcinoma
• Surgery
• Treatment