The Role of Minimally Invasive Surgery in the Treatment of Lung Metastases.
BACKGROUND
The ideal surgical approach for pulmonary metastasectomy remains controversial. Thoracoscopic surgery may offer advantages in quality of life outcomes, with equivalent oncologic long-term results. This study aimed to demonstrate the validity of video-assisted thoracoscopic surgery (VATS) in the treatment of lung metastases.


METHODS
In all 224 patients who underwent 300 VATS metastasectomies from January 2000 to December 2013 were retrospectively reviewed. Sixty-nine patients underwent major resection (68 thoracoscopic lobectomies and one pneumonectomy) and 155 patients underwent a wedge resection/segmentectomy. Complete curative pulmonary resections were performed in 219 (97%) cases. The Kaplan-Meier method was used to estimate survival curves. Univariate and subsequent multivariate Cox model regression were performed to identify independent factors of overall survival.


RESULTS
One hundred eighty-six patients developed lung metastases from epithelial tumors, 28 from sarcomas, seven from melanomas, and three from germ cell tumors. The final pathological examination revealed no cases of R1 disease. After a mean follow-up of 40 months, 118 patients (53%) had died. According to a multivariate analysis, a better prognosis was not observed for patients with a particular histological type; in addition, disease-free interval time, age, number of metastases, and type of surgery did not have any statistical influence on long-term survival.


CONCLUSIONS
Thoracoscopic surgery is a safe and efficacious procedure, with a five-year overall survival that is equivalent to open surgery.
a Department of Surgical Oncology , National Cancer Institute of Aviano , Aviano , Italy.
Gian Piero
GP
Guerrini
b Thoracic Surgery Unit , AUSL Romagna, S. Maria delle Croci Hospital , Ravenna , Italy.
Felice
F
Lo Faso
c Department of Surgery , AUSL Romagna, S. Maria delle Croci Hospital , Ravenna , Italy.
Alessio
A
Vagliasindi
d Department of Cardiothoracic and Intensive Care , Istituto Scientifico S. Raffaele , Milan , Italy.
Rosalba
R
Lembo
b Thoracic Surgery Unit , AUSL Romagna, S. Maria delle Croci Hospital , Ravenna , Italy.
Luciano
L
Solaini
c Department of Surgery , AUSL Romagna, S. Maria delle Croci Hospital , Ravenna , Italy.
Paolo
P
Soliani
e Thoracic Surgery Unit , University of Genova, San Martino Hospital , Genova , Italy.
Mario
M
Taviani
f Thoracic Surgery Unit , Bellaria-Maggiore Bologna Hospital , Bologna , Italy.
Calogero
C
Porrello
D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000473:pathology; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology; D059035:Perioperative Period; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
CT scan technology; VATS surgery; minimally invasive; morbidity; pulmonary metastasis