Original article
General thoracic
Resection of Pulmonary Metastases From Sarcoma: Can Some Patients Benefit From a Less Invasive Approach?

https://doi.org/10.1016/j.athoracsur.2008.09.036Get rights and content

Background

Although video-assisted metastasectomy has been proposed for some solitary metastases, its value has not been investigated in patients with pulmonary metastases from sarcoma for which open resection remains the usual approach.

Methods

In all, 113 consecutive patients underwent curatively intended lung resection for metastases from sarcomas. Of these 113 patients, 31 were selected for a thoracoscopic wedge resection (group TS). These patients were compared with 29 patients operated on by thoracotomy but whose features could have made them possible candidates for a thoracoscopic resection (group TT). Follow-up was complete for all patients (mean follow-up, 34 months).

Results

No mortality occurred. No morbidity was observed in group TT, and 1 complication occurred in group TS. The mean postoperative hospital stay was 3.7 days for group TS and 6.2 days for group TT (p < 0.0001). Overall survival rates at 1, 3, and 5 years were, respectively, 87.4%, 70.9%, and 52.5% in group TS, and 82.3%, 63.6%, and 34% in group TT (p = 0.20). Disease-free survival rates at 1 and 3 years were, respectively, 50.5% and 26.4% in group TS and 60% and 24.8% in group TT (p = 0.74). Local recurrence occurred in 1 patient in each group. Survival without a homolateral recurrence (i.e., in the operated lung) at 1 and 3 years was 66.7% and 44.4% in group TS and 83.5% and 45% in group TT, respectively (p = 0.54).

Conclusions

In selected patients with a maximum of two pulmonary nodules, thoracoscopic resections yield survival rates similar to open resections while being less invasive and preserving the patient's ability to undergo possible repeat operations.

Section snippets

Patient Selection

From January 2000 to July 2007, 113 consecutive patients underwent curatively intended lung resection for metastatic disease from sarcomas. Patients were selected for surgery if there was no recurrence at the primary site, no other metastastic sites, if all the detected pulmonary nodules were resectable without major functional compromise, and if they had increased in size but not in number during a surveillance period of at least 2 months. Among these 113 patients, we retrospectively

Results

The 31 patients in group TS had a total of 63 operations, 42 by thoracoscopy and 21 by thoracotomy. Staged bilateral resections were performed within less than a month in 11 patients (35%): in 7 patients, one side was treated by thoracoscopy and the other side by thoracotomy; and 4 patients underwent bilateral thoracoscopy. A total of 11 patients in group TS also had at least one resection performed by thoracotomy: in 7 patients before, and in 4 patients after, their thoracoscopic operation.

Comment

Over the past years, several studies have been published on thoracoscopic resection of PM [6, 7, 8, 9]. Video-assisted thoracic surgery has become an accepted modality in patients presenting with a limited number of lesions, usually fewer than two [10]. This attitude is based on lower morbidity after video-assisted thoracic surgery and its encouraging survival rate [7, 11].

However, very few authors have so far recommended a thoracoscopic approach for PM from sarcoma. In three recent series, all

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