Video-assisted thoracic surgery (VATS) for resection of metastatic adenocarcinoma as an acceptable alternative

David Geffen School of Medicine at UCLA, UCLA, Los Angeles, USA.
Surgical Endoscopy (Impact Factor: 3.31). 09/2009; 23(9):1947-54. DOI: 10.1007/s00464-008-0243-z
Source: PubMed

ABSTRACT Adenocarcinomas commonly metastasize to the lungs and can be resected using open thoracotomy or video-assisted thoracic surgery (VATS). This study reviews metastatic resections in primary adenocarcinoma patients, using both thoracotomy and VATS. We aim to compare long-term prognoses to test the efficacy and viability of VATS.
A retrospective review of primary adenocarcinoma patients who underwent resection of pulmonary metastases from 1990 to 2006 was carried out. Information was obtained by chart review. Endpoints analyzed were disease-free interval (DFI), survival time, and recurrence-free survival (RFS).
In a total of 42 (16 male, 26 female; median age 58.5 years) primary adenocarcinoma patients, 21 patients underwent first pulmonary metastatic resection using VATS (7 male, 14 female; median age 57 years) and 21 using thoracotomy (9 male, 12 female; median age 59 years). Primary adenocarcinomas were mainly 27 colorectal (64%) and 11 breast (26%). Two VATS (10%) and three open patients (14%) had local recurrences of the original cancer. Median postoperative follow was 13.3 months [interquartile range (IQR) 4.5-32.8 months] for VATS and 36.9 months (IQR 19.3-48.6 months) after thoracotomy. Median DFI-1 was 22.3 months (IQR 13.5-40.6 months) for VATS patients and 35.6 months (IQR 26.7-61.3 months) for open patients. Second thoracic occurrences were noted in six VATS patients (median DFI-2 9.2 months), and in seven open patients (median DFI-2 21.5 months). Third thoracic occurrences were noted in one VATS patient (DFI-3 18.7 months) and in one thoracotomy patient (DFI-3 21.8 months). Odds ratio of recurrence showed 12.5% less chance of developing recurrence in VATS patients. Five-year RFS was 53% in VATS and 57% in thoracotomy patients.
VATS has become a viable alternative to open thoracotomy for resection of pulmonary metastases. In cases of primary adenocarcinoma, VATS showed no increase in number of thoracic recurrences, and comparable RFS. Short-term follow-up is encouraging; long-term follow-up will be needed to confirm these results.


Available from: Dawn Jaroszewski, May 30, 2015
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    ABSTRACT: Pulmonary metastasectomy is an acceptable treatment option in various metastatic lesions. The role of minimally invasive surgery for metastasectomy remains controversial. We report on a recently described hybrid video-assisted thoracoscopic surgery (hVATS) technique in the community hospital setting. Using a retrospective study design, data on 61 patients undergoing 67 resections between April 2000 and January 2008 was collected at a single institution. Patient demographics, pathology, and clinical outcome data were recorded. Kaplan Meier estimates and multivariate Cox regression were used to assess survival and prognostic factors, respectively. Mean patient age was 61.7 years. The majority of lesions were solitary, unilateral, and genitourinary or gastrointestinal in origin (69%). R0 resection was achieved in 97% of cases with the most common operation being lobectomy. Mean length of stay was 4.4 days. Mean follow-up was 39.7 months and 5-year overall survival was 63.2% for the cohort; median survival was not reached. The number of lesions (univariate only) and tumor size over 4 cm influenced overall survival. Hybrid VATS is a safe and feasible technique in the community medical center setting and warrants additional investigation as an alternative strategy in the management of pulmonary metastases.