Thoracoscopic lung metastasectomies: a 10-year, single-center experience.
BACKGROUND
The ideal surgical treatment for pulmonary metastasectomy remains controversial. Minimally invasive surgery may offer advantages for quality of life outcomes, with equivalent oncologic long-term results. The purpose of our study was to confirm the validity of the thoracoscopic approach for pulmonary metastasectomy.


METHODS
We retrospectively reviewed 164 patients who underwent 212 lung metastasectomies from January 2000 to December 2010. Complete curative pulmonary resections were performed in 159 (96.95 %) cases; 126 patients developed lung metastases from epithelial tumors: 28 from sarcoma, 7 from melanoma, and 3 from germ cell tumors. The mean disease-free interval (DFI) was 38.75 months. Fifty-four patients underwent a major VATS resection (53 thoracoscopic lobectomies and 1 pneumonectomy), and 110 patients underwent a wedge resection/segmentectomy. Lymph node sampling was performed in 117 cases.


RESULTS
After a mean follow-up of 38 months, 87 patients (53 %) had died. All resection margins were tumor-free at final pathological examination. Multivariate analysis not confirmed in our series a better prognosis for patients with a particular histologic type and also DFI, age, number of metastases, and type of surgery did not statistically influence long-term survival.


CONCLUSIONS
Thoracoscopic surgery is an acceptable procedure, safe and efficacious, with a 5-year overall survival that is equivalent to open surgery.
Thoracic Surgery Unit, ASL Ravenna, Maria Cecilia Hospital, Via Corriera 1, 48010, Cotignola, Ravenna, Italy. felice_lo_faso@yahoo.com
Felice
F
Lo Faso
Luciano
L
Solaini
Rosalba
R
Lembo
Paolo
P
Bagioni
Silvia
S
Zago
Paolo
P
Soliani
Robert D
RD
Pascotto
D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery*; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012509:Sarcoma / Q000556:secondary / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome