title: Pulmonary metastasectomy - A retrospective comparison of surgical outcomes after laser-assisted and conventional resection.
abstract: BACKGROUND
  Indications and surgical techniques for pulmonary metastasectomy (PME) are controversially discussed issues. Laser-assisted surgery (LAS) is a recent innovation that has been advocated especially in patients with multiple pulmonary metastases (PM). However, there are hardly any studies comparing surgical outcomes after laser-assisted and conventional resection. The aim of the current study was to evaluate the value of LAS in a larger study population.
  
  
  METHODS
  A retrospective analysis was completed on 178 consecutive patients undergoing 236 PMEs at a single center between 2010 and 2015. The main endpoint was survival. Statistical analysis was performed using the Kaplan-Meier method and survival rates were compared with the log rank test. Follow-up was done with special attention to the development of recurrent PM. Local relapse was defined as a recurrent metastasis in direct relation to the previously resected area according to CT scan comparisons.
  
  
  RESULTS
  LAS was performed on 256 metastases in 99 patients, non-laser-assisted surgery (NLAS) on 127 metastases in 79 patients. 5-year-survival rates were 69.3% in all patients, 65.7% after LAS and 73.6% after NLAS. There was no statistically significant survival difference after LAS or NLAS (p = 0.41). The rate of local relapse was 0.8% after LAS vs 3.1% after NLAS (p = 0.073).
  
  
  CONCLUSIONS
  Despite a larger number of negative predictors for survival in LAS patients, overall survival (OS) was similar in the compared groups. There was also a trend for a lower risk of local relapses after LAS. Therefore, LAS should be considered a promising method for PME.
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. Electronic address: katharina.franzke@stud.mh-hannover.de.
authors: K
authors: K
authors: Franzke
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: R
authors: R
authors: Natanov
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: N
authors: N
authors: Zinne
authors: Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
authors: T K
authors: TK
authors: Rajab
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: C
authors: C
authors: Biancosino
authors: Centre for Oncology, Rundestraße 10, Hannover, Germany.
authors: I
authors: I
authors: Zander
authors: Centre for Internal Medicine, DIAKOVERE Friederikenstift, Hannover, Germany.
authors: S
authors: S
authors: Lodziewski
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: M
authors: M
authors: Ricklefs
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: I
authors: I
authors: Kropivnitskaya
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: J D
authors: JD
authors: Schmitto
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: A
authors: A
authors: Haverich
authors: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; Department of Thoracic Surgery, Martha-Maria Hospital, Halle-Dölau, Germany.
authors: M
authors: M
authors: Krüger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: Local relapse; Lung metastases; Nd:Yag laser; Pulmonary metastasectomy