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Carr SR, Villa Hernandez F, Varghese DG, Choo-Wosoba H, Steinberg SM, Teke ME, Del Rivero J, Schrump DS, Hoang CD. Pulmonary Metastasectomy for Adrenocortical Carcinoma-Not If, but When. Cancers (Basel) 2024; 16:702. [PMID: 38398093 PMCID: PMC10886862 DOI: 10.3390/cancers16040702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) commonly metastasizes to the lungs, and pulmonary metastasectomy (PM) is utilized due to limited systemic options. METHODS All ACC patients with initially only lung metastases (LM) from a single institution constituted this observational case series. Kaplan-Meier and Cox proportional hazard analyses evaluated the association with potential prognostic factors and outcomes. Overall survival (OS) was calculated from the date of the PM or, in those patients who did not undergo surgery, from the development of LM. RESULTS A total of 75 ACC patients over a 45-year period met the criteria; 52 underwent PM, and 23 did not. The patients undergoing PM had a median OS of 3.1 years (95% CI: 2.4, 4.7 years) with the 5- and 10-year OS being 35.5% and 32.8%, respectively. The total resected LM did not impact the OS nor the DFS. The patients who developed LM after 11 months from the initial ACC resection had an improved OS (4.2 years; 95% CI: 3.2, NR; p = 0.0096) compared to those developing metastases earlier (2.4 years; 95% CI: 1.6, 2.8). Patients who underwent PM within 11 months of adrenalectomy demonstrated a reduced OS (2.2 years; 95% CI: 1.0, 2.7) compared to those after 11 months (3.6 years, 95% CI: 2.6, NR; p = 0.0045). PM may provide benefit to those patients with LM at presentation (HR: 0.5; p = 0.2827), with the time to first PM as a time-varying covariate. CONCLUSIONS PM appears to have a role in ACC patients. The number of nodules should not be an exclusion factor. Patients developing LM within a year of primary tumor resection may benefit from waiting before further surgeries, which may provide additional insight into who may benefit from PM.
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Affiliation(s)
- Shamus R. Carr
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Frank Villa Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; (F.V.H.); (M.E.T.)
| | - Diana Grace Varghese
- Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; (D.G.V.)
| | - Hyoyoung Choo-Wosoba
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Seth M. Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Martha E. Teke
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; (F.V.H.); (M.E.T.)
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; (D.G.V.)
| | - David S. Schrump
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Chuong D. Hoang
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
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Lee BM, Chang JS, Koom WS, Byun HK, Kim HS, Beom SH, Oh C, Suh YJ, Ahn JB, Shin SJ, Park BJ, Park SY. Importance of Local Ablative Therapies for Lung Metastases in Patients With Colorectal Cancer. Ann Surg 2023; 278:e173-e178. [PMID: 35837890 DOI: 10.1097/sla.0000000000005466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effect of local ablative therapy (LAT) on overall survival in patients with lung metastases from colorectal cancer (CRC) compared with patients treated with systemic therapy. SUMMARY BACKGROUND DATA CRC affects approximately 1.4 million individuals worldwide every year. The lungs are commonly affected by CRC, and there is no treatment standard for a secondary lung metastasis from CRC. METHODS This longitudinal, retrospective cohort study (2010-2018) quantified the pulmonary and extrapulmonary tumor burden of 1143 patients by retrospectively reviewing computed tomography images captured at diagnosis. A comprehensive multidisciplinary approach informed how and when surgery and/or stereotactic body radiotherapy was administered. RESULTS Among 1143 patients, 473 patients (41%) received LAT, with surgery first (n = 421) or stereotactic ablative radiation therapy first (n = 52) either at the time of diagnosis (n = 288), within 1 year (n = 132), or after 1 year (n = 53). LAT was repeated in 158 patients (33.4%, 384 total sessions) when new lung metastases were detected. The 5- and 10-year survival rates for patients treated with LAT (71.2% and 64.0%, respectively) were significantly higher than those of patients treated with systemic therapy alone (14.2% and 10.0%, respectively; P <0.001). The overall survival of patients who received LAT intervention increased as the total tumor burden decreased. CONCLUSIONS A high long-term survival rate was achievable in a significant portion of patients with lung metastasis from CRC by the timely administrations of LAT to standard systemic therapy. The tumor burden and LAT feasibility should be included in a discussion during the follow-up period.
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Affiliation(s)
- Byung Min Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han Sang Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hoon Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Caleb Oh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Suh
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Yamamoto H, Yamamoto H, Soh J, Suzuki E, Namba K, Suzawa K, Miyoshi K, Otani S, Okazaki M, Sugimoto S, Yamane M, Yorifuji T, Takahashi K, Toyooka S. A Simple Prognostic Benefit Scoring System for Sarcoma Patients with Pulmonary Metastases: Sarcoma Lung Metastasis Score. Ann Surg Oncol 2020; 28:3884-3890. [PMID: 33236252 DOI: 10.1245/s10434-020-09272-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/03/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pulmonary metastasectomy could be considered one of the treatment options for disease control in sarcoma patients with pulmonary metastases; however, there is little consensus regarding the suitable criteria for predicting the likely outcomes in these patients. The aim of this study was to establish a prognostic benefit scoring system based on preoperatively examined prognostic factors for sarcoma patients with pulmonary metastases. METHODS This was a single-center, retrospective cohort study conducted in a cohort of 135 sarcoma patients who underwent a first pulmonary metastasectomy at Okayama University Hospital between January 2006 and December 2015. Based on the results of a multivariable logistic regression analysis performed to determine the factors influencing 3-year mortality, a Sarcoma Lung Metastasis Score was created and its correlation with 3-year survival was analyzed. RESULTS The results of the multivariate analysis revealed significant differences in the disease-free interval (< 2 years vs. ≥ 2 years; odds ratio (OR) 4.22, 95% confidence interval (CI) 1.67-10.70), maximum tumor diameter (≥ 15 mm vs. < 15 mm; OR 3.86, 95% CI 1.75-8.52), and number of pulmonary metastases (≥ 6 vs. < 6; OR 2.65, 95% CI 1.06-6.620). The Sarcoma Lung Metastasis Score, which was defined as the total score of these three factors, reliably predicted 3-year survival (score: 0, 89.5%; 1, 63.2%; 2, 39.0%; 3, 10.5%). CONCLUSIONS Our newly proposed simple Sarcoma Lung Metastasis Score appears to be a useful prognostic predictor for sarcoma patients with pulmonary metastases, in that it could be helpful for the selection of appropriate treatments for these patients.
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Affiliation(s)
- Haruchika Yamamoto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
| | - Hiromasa Yamamoto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan.
| | - Junichi Soh
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
| | - Etsuji Suzuki
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
| | - Kei Namba
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
| | - Ken Suzawa
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
| | - Shinji Otani
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
| | - Mikio Okazaki
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
| | - Masaomi Yamane
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-City, Okayama, Japan
| | - Katsuhito Takahashi
- Center for Multidisciplinary Treatment of Sarcoma, Department of Sarcoma Medicine, Kameda Medical Center, Kamogawa-City, Chiba, Japan
| | - Shinichi Toyooka
- Department of Thoracic Surgery, Okayama University Hospital, Okayama-City, Okayama, Japan
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Wang Y, Delisle M, Smith D, Srikanthan A. Survival by histology among patients with bone and soft tissue sarcoma who undergo metastasectomy: protocol for a systematic review and meta-analysis. Syst Rev 2020; 9:189. [PMID: 32819423 PMCID: PMC7441630 DOI: 10.1186/s13643-020-01445-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 08/05/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Metastasectomy is performed on a select cohort of patients with advanced and/or recurrent bone and soft tissue sarcomas because of the potential for long term relapse free and overall survival associated with the procedure. However, the evidence supporting metastasectomy is difficult to summarize without a systematic examination of existing literature. The objective of this systematic review will be to examine survival among both adults and children with advanced and recurrent bone and STS who undergo metastasectomy. METHODS We designed and registered a study protocol for a systematic review and meta-analysis. We will include data from survival studies (e.g., randomized trials, cohort studies, routine case registries, and case control) conducted in children and adults with advanced and recurrent bone and soft tissue sarcoma who undergo metastasectomy. The primary outcome will be overall survival. Secondary outcomes will be 30-day post-operative mortality, recurrence-free survival, time off systemic therapy, and patient-reported outcomes including quality of life end points where available. Literature searches will be performed in multiple electronic databases including Ovid MEDLINE ® (1946 to present), Ovid EMBASE (1974 to present), Web of Science, and Cochrane Library. Grey literature will be identified through searching references, conference abstracts, Papers First, and Google Scholar. Two investigators will independently screen all citations, full-text articles, and abstract data. Full-text articles selected for analysis will be assessed for quality and risk of bias. If feasible, we will conduct a random effects meta-analysis. Estimates will be stratified according to histology comparing survival based on organ of metastasectomy. Additional analysis will be conducted to explore the potential sources of heterogeneity according to various patient, disease, and treatment characteristics (e.g., metastasis status, age, disease burden, and concomitant interventions). DISCUSSION This systematic review and meta-analysis will identify, evaluate, and integrate data on survival of metastasectomy of bone and soft tissue sarcoma by organ of metastasis. Our findings may have implications for clinicians, patients, and their families when considering selection for resection of oligometastatic disease in de novo, or recurrent bone and soft tissue sarcoma. Implications for future research will be identified to improve the outcomes of these complex patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019126906.
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Affiliation(s)
- Ying Wang
- BC Cancer Vancouver, University of British Columbia, 600 West 10th Ave, Vancouver, V5Z 3E6, Canada
| | - Megan Delisle
- General Surgery Residency Program Department, University of Manitoba, 347-825 Sherbrook Street, Winnipeg, MB, R3T 2 N2, Canada
| | - Denise Smith
- Faculty of Health Sciences, Health Sciences Library, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4 L8, Canada
| | - Amirrtha Srikanthan
- The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, K1H 8 L6, Canada.
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Surgical treatment of metastatic diseases to the lung. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:52-60. [PMID: 32728365 PMCID: PMC7379223 DOI: 10.5114/kitp.2020.97254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
Introduction The problem of treating secondary cancer is very controversial. Huge progress in its treatment began in the 1970s with the introduction of chemotherapy. In the surgical aspect Pastorino’s work published in 1997 was a milestone. To this day, most authors cite its research results. Aim The task is to answer the question what tactics to follow in the surgical treatment of patients with secondary cancer affecting the respiratory system. Material and methods Retrospective studies were conducted on a group of 577 patients. Men prevailed slightly. The average age was 56 years. Surgical access used in the vast majority of cases was anterolateral thoracotomy. Wedge resection was the most common scope of surgery. Lymph nodes were not removed as standard. Single and multifactorial statistical surveys were conducted (Kaplan-Meier estimator and multifactorial Cox regression analysis). Results A total of 1,058 operations were performed during which 1889 metastases were removed. Negative tissue margins were obtained in 90.4%. The median survival was 47 months. Complications occurred in 76 patients, which constituted 7.1% of performed procedures. There were 3 perioperative deaths. Conclusions It was found that the factors negatively affecting survival were lack of radicalism, size of the metastasis > 3 cm, and number of metastases > 1. The factors positively influencing survival were a longer time than primary surgery and a greater number of operations. Histological diagnosis differentiated patient survival.
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Spencer RMSSB, de Camargo VP, Silva MLG, Pinto FFE, Costa FD, Cequeira WS, Munhoz RR, Mello CA, Schmerling RA, Filho WJD, Coelho TM, Ambrosio AVA, Leite ETT, Hanna SA, Nakagawa SA, Baptista AM, Pinheiro RN, de Oliveira JL, de Araújo MS, de Araujo RLC, Laporte GA, de Almeida Quadros C, de Oliveira AF, Lopes A. Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas. J Surg Oncol 2020; 121:743-758. [PMID: 31970785 DOI: 10.1002/jso.25847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Soft tissue sarcomas (STSs) are rare tumors and constitute only 1% of all tumors in adults. Indeed, due to their rarity, most cases in Brazil are not treated according to primary international guidelines. METHODS This consensus addresses the treatment of STSs in the extremities. It was made by workgroups from Brazilian Societies of Surgical Oncology, Orthopaedics, Clinical Oncology, Pathology, Radiology and Diagnostic Imaging, and Radiation Oncology. The workgroups based their arguments on the best level of evidence in the literature and recommendations were made according to diagnosis, staging, and treatment of STSs. A meeting was held with all the invited experts and the topics were presented individually with the definition of the degree of recommendation, based on the levels of evidence in the literature. RESULTS Risk factors and epidemiology were described as well as the pathological aspects and imaging. All recommendations are described with the degree of recommendation and levels of evidence. CONCLUSION Recommendations based on the best literature regional aspects were made to guide professionals who treat STS. Separate consensus on specific treatments for retroperitoneal, visceral, trunk, head and neck sarcomas, and gastrointestinal stromal tumor, are not contemplated into this consensus.
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Affiliation(s)
- Ranyell M S S B Spencer
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Veridiana P de Camargo
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Maria L G Silva
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Fabio F E Pinto
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | | | - Wagner S Cequeira
- AC Camargo Cancer Center, Department of Diagnosis and Imaging, São Paulo, Brazil
| | - Rodrigo R Munhoz
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Celso A Mello
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Rafael A Schmerling
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Waldec J D Filho
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Tharcisio M Coelho
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Alexandre V A Ambrosio
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Elton T T Leite
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Samir A Hanna
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Sueli A Nakagawa
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | - Andre M Baptista
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | - Rodrigo N Pinheiro
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Jadivan L de Oliveira
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Marcelo Sá de Araújo
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Raphael L C de Araujo
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Gustavo A Laporte
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | | | - Alexandre F de Oliveira
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Ademar Lopes
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
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Grilley-Olson JE, Webber NP, Demos DS, Christensen JD, Kirsch DG. Multidisciplinary Management of Oligometastatic Soft Tissue Sarcoma. Am Soc Clin Oncol Educ Book 2018; 38:939-948. [PMID: 30231386 DOI: 10.1200/edbk_200573] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft tissue sarcomas (STS) encompass a group of rare but heterogeneous diseases. Nevertheless, many patients, particularly those with oligometastatic disease can benefit from thoughtful multimodality evaluation and treatment regardless of the STS subtype. Here, we review surgical, interventional radiology, radiation, and chemotherapy approaches to maximize disease palliation and improve survival, including occasionally long-term disease-free survival. Surgical resection can include lung or other visceral, soft tissue and bone metastases with a goal of rendering the patient disease free. Staged resections can be appropriate, and serial resection of oligometastatic recurrent disease can be appropriate. Retrospective series suggest survival benefit from this approach, although selection bias may contribute. Interventional radiology techniques such as percutaneous thermal ablation (PTA) and arterial embolization can present nonoperative local approaches in patients who are not medically fit for surgery, surgery is too morbid, or patients who decline surgery. Similarly, radiation therapy can be delivered safely to areas that are inaccessible surgically or would result in excessive morbidity. Currently no randomized trials exist comparing interventional radiologic approaches or radiation therapy to surgery but retrospective reviews show relatively similar magnitude of benefit in terms of disease palliation and survival, although it is felt unlikely that these procedures will render a patient to long-term disease-free status. Chemotherapy has evolved recently with the addition of several new treatment options, briefly reviewed here. Importantly, if a patient sustains a good response to chemotherapy resulting in true oligometastatic disease, consideration of multimodality local therapy approaches can be considered in the appropriate patient.
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Affiliation(s)
- Juneko E Grilley-Olson
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - Nicholas P Webber
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - David S Demos
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - Jared D Christensen
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - David G Kirsch
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
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Saleh W, AlShammari A, Sarraj J, AlAshgar O, Ahmed MH, AlKattan K. Surgical treatment of pulmonary metastasis: report from a tertiary care center. Asian Cardiovasc Thorac Ann 2018; 26:296-301. [PMID: 29587522 DOI: 10.1177/0218492318767795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective This retrospective analysis aimed to determine the factors influencing prognosis in adult patients who presented to our thoracic surgery service with lung metastases and were eligible for pulmonary metastasectomy. Methods We retrospectively reviewed the data of 296 patients who underwent resection of 575 lung metastases from January 2000 to January 2016. Univariate and multivariate analyses were performed based on age, sex, histology of the primary tumor, disease-free interval, number and size of metastases. Results Sixty-eight (22.97%) patients developed lung metastases from bone sarcoma, 68 (22.97%) from soft-tissue sarcoma, 56 (18.9%) from head and neck cancers, 46 (15.5%) from colorectal cancer, and 58 (19.6%) from other epithelial tumors. The mean size of the lung nodules was 2.48 cm. Open surgical resection was performed in 217 (73.3%) patients. After a mean follow-up of 43 months, 120 (40.7%) patients had died or were lost to follow-up. Univariate analysis confirmed that patients with bone cancer, soft tissue sarcoma, or colorectal carcinoma had a worse prognosis ( p = 0.0003). Moreover, those with a disease-free interval >24 months had a better 5-year survival ( p = 0.0001). The number and size of metastases, age, and sex had no effect on prognosis. The actuarial survival after complete metastasectomy was 71.6% (95% confidence interval: 66-75) at 2 years and 59.3% (95% confidence interval: 56-64) at 5 years. Conclusions Pulmonary metastasectomy provides good long-term survival. The type of primary tumor and disease-free interval are independent prognostic factors for survival.
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Affiliation(s)
- Waleed Saleh
- 2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah AlShammari
- 1 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jumana Sarraj
- 1 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Omniyah AlAshgar
- 2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed Hussein Ahmed
- 2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khaled AlKattan
- 1 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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9
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Basso SMM, Sulfaro SC, Ubiali P. Editorial on "Growth patterns of pulmonary metastases: should we adjust resection techniques to primary histology and size?". J Thorac Dis 2018; 10:121-125. [PMID: 29600037 PMCID: PMC5863125 DOI: 10.21037/jtd.2017.12.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Stefano M. M. Basso
- Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Sandro C. Sulfaro
- Department of Laboratory Medicine, Pathology and Histopathology Section, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Paolo Ubiali
- Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
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10
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Wiltberger G, Bucher JN, Krenzien F, Benzing C, Atanasov G, Schmelzle M, Hau HM, Bartels M. Extended resection in pancreatic metastases: feasibility, frequency, and long-term outcome: a retrospective analysis. BMC Surg 2015; 15:126. [PMID: 26772176 PMCID: PMC4676881 DOI: 10.1186/s12893-015-0114-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 12/07/2015] [Indexed: 12/15/2022] Open
Abstract
Background Metastases to the pancreas are rare, accounting for less then 2 % of all pancreatic malignancies. However, both the benefit of extended tumor resection and the ideal oncological approach have not been established for such cases; therefore, we evaluated patients with metastasis to the pancreas who underwent pancreatic resection. Methods Between 1994 and 2012, 676 patients underwent pancreatic surgery in our institution. We retrospectively reviewed patients’ medical records according to survival, and surgical and non-surgical complications. Student’s t-test and the log-rank test were used for statistical analysis. Results Eighteen patients (2.7 %) received resection for pancreatic metastases (12 multivisceral resections and 6 standard resections). The pancreatic metastases originated from renal cell carcinoma (n = 10), malignant melanoma (n = 2), neuroendocrine tumor of the ileum (n = 1), sarcoma (n = 1), colon cancer (n = 1), gallbladder cancer (n = 1), gastrointestinal stromal tumor (n = 1), and non-small cell lung cancer (n = 1). The median time between primary malignancy resection to metastasectomy was 83 months (range, 0–228 months). Minor surgical complications (Grade I-IIIa) occurred in six patients (33.3 %) whereas major surgical complications (Grade IIIb-V) occurred in three patients (16.6 %). No patients died during hospitalization. The median follow-up was 76 months (range, 10–165 months). One-year, 3-year and 5-year survival for standard resection versus multivisceral resection was 83, 50, and 56 % versus 83, 66, and 50, respectively. Twelve patients died after a median of 26 months (range, 5–55 months). Conclusions A surgical approach with curative intent is justified in select patients suffering from metastases to the pancreas and offers good long-term survival. The resection of pancreatic metastases of different tumor types was associated with favorable morbidity and mortality when compared with resection of the primary pancreatic malignancies. Our findings also demonstrated that multivisceral resection was feasible, with acceptable long term outcomes, even though morbidity rates tended to be higher after multivisceral resection than after standard resection.
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Affiliation(s)
- Georg Wiltberger
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
| | | | - Felix Krenzien
- Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Benzing
- Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Georgi Atanasov
- Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Schmelzle
- Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Michael Bartels
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
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Abstract
BACKGROUND Isolated pancreatic metastases or pancreatic metastases with limited extrapancreatic disease are uncommon and account for only 2-4% of resected malignant pancreatic lesions in surgical series. However, clear-cell renal cell carcinoma is the predominant primary tumor and accounts for more than 60% of cases with isolated pancreatic metastases. Pancreatectomy is the treatment of choice for most patients with isolated pancreatic metastases from renal cell cancer. SUMMARY This review provides an overview of clinical presentation and diagnosis as well as surgical management, including patient selection for surgery and surgical technique for pancreatic metastases of renal cell carcinoma. KEY MESSAGE Although there is no high-level evidence that surgical resection of pancreatic metastases improves survival, the survival results of several observational series and of systematic reviews are promising and support pancreatic resection as part of a multimodal treatment. The reported median survival and 5-year survival rates after pancreatic resection range from 6 to 10 years and from 55 to 75%, respectively. Pancreatic resection is effective for local control. However, extrapancreatic progression frequently occurs. With the introduction of novel systemic therapy options such as tyrosine kinase inhibitors, the prognosis of metastatic renal cell carcinoma has improved, and this will affect the role of pancreatic resection for metastases. PRACTICAL IMPLICATIONS Pancreatic resection for isolated renal cell carcinoma is safe and effective, may confer a survival benefit and should, therefore, be considered in patients for whom no contraindication for surgery exists.
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Affiliation(s)
- Olive Strobel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
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12
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Colin T, Cornelis F, Jouganous J, Palussière J, Saut O. Patient-specific simulation of tumor growth, response to the treatment, and relapse of a lung metastasis: a clinical case. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40244-014-0014-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
In this paper, a parametrization strategy based on reduced order methods is presented for tumor growth PDE models. This is applied to a new simple spatial model for lung metastasis including angiogenesis. The goal is to help clinicians monitoring tumors and eventually predicting their evolution or response to a particular kind of treatment. To illustrate the whole approach, a clinical case including the natural history of the lesion, the response to a chemotherapy, and the relapse before a radiofrequency ablation is presented.
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13
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Zisis C, Tsakiridis K, Kougioumtzi I, Zarogoulidis P, Darwiche K, Machairiotis N, Zaric B, Katsikogiannis N, Kesisis G, Stylianaki A, Li Z, Zarogoulidis K. The management of the advanced colorectal cancer: management of the pulmonary metastases. J Thorac Dis 2014; 5 Suppl 4:S383-8. [PMID: 24102011 DOI: 10.3978/j.issn.2072-1439.2013.06.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 06/19/2013] [Indexed: 01/16/2023]
Abstract
Pulmonary metastases from colorectal cancer present as systemic manifestation of the disease. As a general principle, the presence of metastases predispose to a poor prognosis. However, the application of some criteria of "operability" permitted the surgical resection resulting in prolonged survival (reported 5-year survival up to 50%), in better quality of life and in the cure of some patients. When the primary tumor site is controlled, and the metastatic disease is limited in lungs without extrapulmonary location (except for resectable or resected hepatic lesion) surgical removal is indicated. As significant prognostic factors in metastasectomies have been reported the synchronous or metachronous caracter of the metastases, the disease free survival, the complete removal of the metastases, the thoracic lymph node invasion, the CEA level before metastasectomy and 1 month after, the solitary vs. multiple pulmonary metastatic locations, the induction chemotherapy, the histological type and differentiation grade, as well as the vascular emboli in histopathological examination. Thorough preoperative evaluation of the patient includes oncological assessment and respiratory functional tests. Alternatively, when the patient is not a good surgical candidate, radiofrequency ablation is an option. Many surgical accesses have been validated, as posterolateral or lateral or even posterior thoracotomy, sternotomy, clamshell incision, and thoracoscopic techniques that offer the advantages of less pain, fast recovery, and less morbidity. Though thoracoscopic metastasectomies have been questioned concerning to the completeness of metastatic removal, no statistical difference in survival has been revealed in many series comparing thoracotomy to thoracoscopic techniques. As a conclusion, there are many advances in the management of pulmonary metastases from colorectal cancer during last decade, the results have been essentially optimized, the role of surgery has been established, and the multimodality approach has been recognized as the cornerstone of a successful outcome.
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Affiliation(s)
- Charalambos Zisis
- Department of Thoracic and Vascular Surgery, 'Evangelismos' Hospital, Athens, Greece
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14
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Lung-conserving treatment of a pulmonary oligometastasis with a wedge resection and 131Cs brachytherapy. Brachytherapy 2013; 12:567-72. [DOI: 10.1016/j.brachy.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 05/01/2013] [Accepted: 05/17/2013] [Indexed: 11/19/2022]
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15
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Gollard RP, Turner JF. Multimodality therapy for metastatic sarcomas confined to the lung. Oncol Lett 2012. [PMID: 23205068 DOI: 10.3892/ol.2012.820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Metastectomy or resection of sarcomas which have metastasized to the lung from other sites has a long and established history. At present, there are more than forty different drugs with activity in soft tissue sarcomas. A number of sarcomas demonstrate differential sensitivities to chemotherapy and targeted agents. Intimate knowledge of the biological behavior of each distinct type of sarcoma should predicate what treatment or protocol is most suitable. Certain patients might benefit from either neoadjuvant or adjuvant therapy following the resection of metastatic lesions. Much remains to be learned about the differential sensitivities of various sarcomas to different treatment regimens.
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op den Winkel J, Pfannschmidt J, Muley T, Grünewald C, Dienemann H, Fassnacht M, Allolio B. Metastatic Adrenocortical Carcinoma: Results of 56 Pulmonary Metastasectomies in 24 Patients. Ann Thorac Surg 2011; 92:1965-70. [DOI: 10.1016/j.athoracsur.2011.07.088] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 07/25/2011] [Accepted: 07/29/2011] [Indexed: 11/29/2022]
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17
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Long H, Zheng Y, Situ D, Ma G, Lin Z, Wang J. Hand-Assisted Thoracoscopic Surgery for Bilateral Lung Metastasectomy Through Sternocostal Triangle Access. Ann Thorac Surg 2011; 91:852-8. [DOI: 10.1016/j.athoracsur.2010.11.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 11/18/2010] [Accepted: 11/23/2010] [Indexed: 02/06/2023]
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18
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Kaifi JT, Gusani NJ, Deshaies I, Kimchi ET, Reed MF, Mahraj RP, Staveley-O'Carroll KF. Indications and approach to surgical resection of lung metastases. J Surg Oncol 2010; 102:187-95. [PMID: 20648593 DOI: 10.1002/jso.21596] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pulmonary metastasectomy is a curative option for selected patients with cancer spread to the lungs. Complete surgical removal of pulmonary metastases can improve survival and is recommended under certain criteria. Specific issues that require consideration in a multidisciplinary setting when planning pulmonary metastasectomy include: adherence to established indications for resection, the surgical strategy including the use of minimally invasive techniques, pulmonary parenchyma preservation, and the role of lymphadenectomy.
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Affiliation(s)
- Jussuf T Kaifi
- Section of Surgical Oncology, Department of Surgery, Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, Pennsylvania 17033-0850, USA
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Strobel O, Hackert T, Hartwig W, Bergmann F, Hinz U, Wente MN, Fritz S, Schneider L, Büchler MW, Werner J. Survival data justifies resection for pancreatic metastases. Ann Surg Oncol 2009; 16:3340-9. [PMID: 19777190 DOI: 10.1245/s10434-009-0682-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pancreatic metastases are uncommon and little is known about the oncologic outcome after resection or prognostic parameters. This study was designed to evaluate perioperative and follow-up results after resection for pancreatic metastases and to define prognostic factors. METHODS From a prospective database, all consecutive resections performed at our institution for pancreatic metastases between October 2001 and July 2008 were identified. Clinicopathological details, perioperative, and follow-up results were analyzed. Uni- and multivariate analysis were performed to identify parameters associated with overall and disease-free survival. RESULTS Forty-four resections were performed for pancreatic metastases. Primary tumors included 31 (70%) renal cell carcinomas (RCC) and 13 other primary tumors. Morbidity was 33% and mortality 4.4%. Pancreatic metastases occurred after a median interval of 6.9 years after resection of the primary tumor. Twenty-five patients (57%) had additional extrapancreatic disease. With a median follow-up of 32.1 months, overall 3- and 5-year survivals were 70.2% and 56.8%, disease-free 3- and 5-year survivals were 37.2% and 33%, respectively. Patients with isolated pancreatic metastases had an overall 3- and 5-year survival of 85.6% and 74.9%. Additional extrapancreatic disease, a disease-free interval of less than 36 months, and non-RCC entity were associated with shorter overall survival. Previous recurrence, non-RCC primary tumors, and a disease-free interval of less than 36 months were associated with shorter disease-free survival. CONCLUSIONS Resection for pancreatic metastases can be performed safely and with good follow-up results and can be recommended as part of an interdisciplinary treatment. Especially in patients with isolated pancreatic metastases, long-term survival can be expected.
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Affiliation(s)
- Oliver Strobel
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
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20
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Bar J, Herbst RS, Onn A. Targeted drug delivery strategies to treat lung metastasis. Expert Opin Drug Deliv 2009; 6:1003-16. [PMID: 19663628 DOI: 10.1517/17425240903167926] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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