title: Local treatment of pulmonary metastases: from open resection to minimally invasive approach? Less morbidity, comparable local control.
abstract: BACKGROUND
  The level of evidence for efficacy of local treatment of pulmonary metastases is low; therefore, complication rates should be minimized. Minimally invasive techniques may have the potential to reduce morbidity but potentially lead to more local and/or ipsilateral recurrences. The objective of this study was to evaluate the introduction of a new treatment strategy incorporating the increased use of video-assisted thoracic surgery (VATS) and radiofrequency ablation (RFA), weighing complications against recurrence rates.
  
  
  METHODS
  We retrospectively reviewed results of all local treatment of pulmonary metastases in the Netherlands Cancer Institute from 2002 to 2007. Each of 158 identified interventions was analyzed separately to retrieve procedure-related data. Overall survival data were analyzed per patient. To evaluate the introduction of a strategy incorporating minimally invasive techniques, the study period was split in two (before and after the introduction of this strategy in July 2004).
  
  
  RESULTS
  In Strategy I, 47 interventions (2 VATS, no RFA) were performed in 37 patients; in Strategy II 111 interventions (51 VATS and RFA) in 86 patients. Metastases of a variety of primary tumors were treated. Median hospital stay was shorter (5 vs. 7 days) and procedure-related morbidity was less with Strategy II (p < 0.01). Time-to-recurrence rates were comparable (p = 0.18), as were local and ipsilateral recurrence rates within 3 years (p = 0.72). Estimated overall 3-year survival was 59% for patients treated with Strategy I and 54% with Strategy II.
  
  
  CONCLUSIONS
  Increased use of minimally invasive techniques for local treatment of pulmonary metastatic disease is associated with low morbidity, without apparent reduction in (local) disease control.
authors.affiliation: Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoekziekenhuis, PO Box 90203, 1006, BE, Amsterdam, The Netherlands. emvonm@gmail.com
authors.forename: Erik M
authors.initials: EM
authors.lastname: von Meyenfeldt
authors.forename: Michel W
authors.initials: MW
authors.lastname: Wouters
authors.forename: Nathalie Lai A
authors.initials: NL
authors.lastname: Fat
authors.forename: Warner
authors.initials: W
authors.lastname: Prevoo
authors.forename: Sjaak A
authors.initials: SA
authors.lastname: Burgers
authors.forename: Johanna W
authors.initials: JW
authors.lastname: van Sandick
authors.forename: Houke M
authors.initials: HM
authors.lastname: Klomp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods* / Q000401:mortality; D055815:Young Adult