Randomized controlled trial of pulmonary metastasectomy in colorectal cancer: PulMiCC International is open in Italy

[Pulmonary metastases: classification and the need for staging?]

AIM

To analyze pulmonary metastases classifications which are used in Russian and foreign literature at present time.

MATERIAL AND METHODS

It is proposed the variant of pulmonary metastases staging depending on quantitative and regional prevalence of the process.

RESULTS

The development of pulmonary metastases classification is advisable to determine homogeneous subgroups of patients with metastatic lesion for prospective randomized trials in order to obtain objective results about the results of surgical or other local treatment of patients with intrapulmonary metastases.

The Role of Minimally Invasive Surgery in the Treatment of Lung Metastases

INTRODUCTION

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.

Wider implications of video-assisted thoracic surgery versus open approach for lung metastasectomy

ABSTRACT 

Lung metastasectomy is considered a safe and potentially curative procedure despite there is not a strong evidence that metastasectomy prolongs long-term survival in patients with lung metastases. Moreover, the debate is open regarding the best approach for lung metastasectomy, video-assisted thoracic surgery versus open approach. A systematic review of literature to clarify what is the best approach to prolong survival in patients with lung metastases was performed. Our study confirms that overall survival is equivalent for video-assisted thoracic surgery and thoracotomy, therefore the ‘gold standard’ surgical treatment for lung metastases remains a point of debate. The choice of the surgical approach still depends more on the single center or surgeon practice than on strong scientific evidence. A prospective randomized trial could clarify the question.