Resection of pulmonary metastases from sarcoma: can some patients benefit from a less invasive approach?
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.
Gossot
Dominique
D
Thoracic Department, Institut Mutualiste Montsouris, Paris, France. dominique.gossot@imm.fr
Radu
Costin
C
Girard
Philippe
P
Le Cesne
Axel
A
Bonvalot
Sylvie
S
Boudaya
Mohamed Sadok
MS
Validire
Pierre
P
Magdeleinat
Pierre
P
D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012509:Sarcoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods* / Q000401:mortality; D013908:Thoracotomy / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome