Journal of cardiothoracic surgery · 2021
Survival prognostic and recurrence risk factors after single pulmonary metastasectomy.
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Forster Céline, Ojanguren Amaya, Perentes Jean Yannis, Zellweger Matthieu, Krueger Thorsten, Abdelnour-Berchtold Etienne, Gonzalez Michel
Аннотация
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.
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.