Download PDF
Thorac Cardiovasc Surg 2023; 71(02): 121-129
DOI: 10.1055/s-0042-1744476
Original Thoracic

Experience of Simultaneous Bilateral Open Surgery and VATS for Pulmonary Metastasectomy

Yu-Wei Liu
1   Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
2   Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
,
Andre Chou
3   Poznañ University of Medical Sciences, Poznañ, Poland
,
Shah-Hwa Chou 
1   Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
2   Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
› Author Affiliations
› Further Information
   Permissions and Reprints All articles of this category

Abstract

Background Resection is the current treatment of choice for resectable bilateral pulmonary metastases. This study aimed to compare the differences in outcomes between simultaneous bilateral open and video-assisted thoracic surgery (VATS) for pulmonary metastasectomy.

Methods Forty-three patients underwent pulmonary metastasectomy through one-stage bilateral open thoracotomy (n = 16) and VATS (n = 27) between 2011 and 2020. Perioperative and oncological data were analyzed.

Results The predominant primary tumor histology in both groups was colorectal cancer. The operative time, blood loss, and pain score on postoperative day 1 (POD1) were higher in the open group (p < 0.001, 0.009, and 0.03, respectively). No significant differences in pain score on POD2 and POD3, postoperative length of stay, or complications were found. Notably, numbers of the resected metastatic lung nodules were significantly greater in the open group (median number: 9.5 vs. 3, p < 0.001). Recurrence-free survival (RFS) and overall survival (OS) were comparable. The median RFS was 15 months (interquartile range [IQR], 6–22) in the open group and 18 months (IQR, 8–47) in the VATS group. The median OS was 28 months (IQR, 14–44) and 29 months (IQR, 15–54) in the open group and VATS group, respectively.

Conclusion One-stage bilateral pulmonary metastasectomy is safe and reduces medical expenditures in selected patients regardless of surgical approach. Although the open group harbored a greater number of metastatic foci, perioperative and oncological outcomes were similar to that of the VATS group.

Keywords

metastases/metastasectomy - thoracoscopy/VATS - surgery/incisions


Publication History

Received: 24 November 2021

Accepted: 09 February 2022

Article published online:
13 March 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Thomford NR, Woolner LB, Clagett OT. The surgical treatment of metastatic tumors in the lungs. J Thorac Cardiovasc Surg 1965; 49: 357-363
    CrossrefPubMedGoogle Scholar
  • 2 Pastorino U, Buyse M, Friedel G. et al; International Registry of Lung Metastases. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 1997; 113 (01) 37-49
    CrossrefPubMedGoogle Scholar
  • 3 Nakas A, Klimatsidas MN, Entwisle J, Martin-Ucar AE, Waller DA. Video-assisted versus open pulmonary metastasectomy: the surgeon's finger or the radiologist's eye?. Eur J Cardiothorac Surg 2009; 36 (03) 469-474
    CrossrefPubMedGoogle Scholar
  • 4 Abdelnour-Berchtold E, Perentes JY, Ris HB. et al. Survival and local recurrence after video-assisted thoracoscopic lung metastasectomy. World J Surg 2016; 40 (02) 373-379
    CrossrefPubMedGoogle Scholar
  • 5 Prenafeta Claramunt N, Hwang D, de Perrot M. et al. Incidence of ipsilateral side recurrence after open or video-assisted thoracic surgery resection of colorectal lung metastases. Ann Thorac Surg 2020; 109 (05) 1591-1597
    CrossrefPubMedGoogle Scholar
  • 6 Markowiak T, Dakkak B, Loch E. et al. Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival. J Cardiothorac Surg 2021; 16 (01) 84
    CrossrefPubMedGoogle Scholar
  • 7 Eckardt J, Licht PB. Thoracoscopic versus open pulmonary metastasectomy: a prospective, sequentially controlled study. Chest 2012; 142 (06) 1598-1602
    CrossrefPubMedGoogle Scholar
  • 8 Cerfolio RJ, Bryant AS, McCarty TP, Minnich DJ. A prospective study to determine the incidence of non-imaged malignant pulmonary nodules in patients who undergo metastasectomy by thoracotomy with lung palpation. Ann Thorac Surg 2011; 91 (06) 1696-1700 , discussion 1700–1701
    CrossrefPubMedGoogle Scholar
  • 9 Eckardt J, Licht PB. Thoracoscopic or open surgery for pulmonary metastasectomy: an observer blinded study. Ann Thorac Surg 2014; 98 (02) 466-469 , discussion 469–470
    CrossrefPubMedGoogle Scholar
  • 10 Macherey S, Doerr F, Heldwein M, Hekmat K. Is manual palpation of the lung necessary in patients undergoing pulmonary metastasectomy?. Interact Cardiovasc Thorac Surg 2016; 22 (03) 351-359
    CrossrefPubMedGoogle Scholar
  • 11 Meng D, Fu L, Wang L. et al. Video-assisted thoracoscopic surgery versus open thoracotomy in pulmonary metastasectomy: a meta-analysis of observational studies. Interact Cardiovasc Thorac Surg 2016; 22 (02) 200-206
    CrossrefPubMedGoogle Scholar
  • 12 Rusidanmu A, Chin W, Xu J. et al. Does a thoracoscopic approach provide better outcomes for pulmonary metastases?. J Thorac Dis 2021; 13 (04) 2692-2697
    CrossrefPubMedGoogle Scholar
  • 13 Kaifi JT, Gusani NJ, Deshaies I. et al. Indications and approach to surgical resection of lung metastases. J Surg Oncol 2010; 102 (02) 187-195
    CrossrefPubMedGoogle Scholar
  • 14 Higashiyama M, Tokunaga T, Nakagiri T, Ishida D, Kuno H, Okami J. Pulmonary metastasectomy: outcomes and issues according to the type of surgical resection. Gen Thorac Cardiovasc Surg 2015; 63 (06) 320-330
    CrossrefPubMedGoogle Scholar
  • 15 Paul S, Altorki NK, Sheng S. et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 2010; 139 (02) 366-378
    CrossrefPubMedGoogle Scholar
  • 16 Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 2009; 27 (15) 2553-2562
    CrossrefPubMedGoogle Scholar
  • 17 Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol 2016; 17 (06) 836-844
    CrossrefPubMedGoogle Scholar
  • 18 Feldman HA, Zhou N, Antonoff MB. et al. Simultaneous versus staged resections for bilateral pulmonary metastases. J Surg Oncol 2021; 123 (07) 1633-1639
    CrossrefPubMedGoogle Scholar
  • 19 Mizuno Y, Iwata H, Shirahashi K, Takemura H. One-stage bilateral pulmonary resections for pulmonary metastases. Gen Thorac Cardiovasc Surg 2014; 62 (01) 53-57
    CrossrefPubMedGoogle Scholar
  • 20 Han KN, Kang CH, Park IK, Kim YT. Thoracoscopic approach to bilateral pulmonary metastasis: is it justified?. Interact Cardiovasc Thorac Surg 2014; 18 (05) 615-620
    CrossrefPubMedGoogle Scholar
  • 21 Matsubara T, Toyokawa G, Kinoshita F. et al. Safety of simultaneous bilateral pulmonary resection for metastatic lung tumors. Anticancer Res 2018; 38 (03) 1715-1719
    PubMedGoogle Scholar
  • 22 Rusch VW. Pulmonary metastasectomy. Current indications. Chest 1995; 107 (6, Suppl): 322S-331S
    CrossrefPubMedGoogle Scholar
  • 23 Liu YW, Yan FW, Tsai DL. et al. Expedite recovery from esophagectomy and reconstruction for esophageal squamous cell carcinoma after perioperative management protocol reinvention. J Thorac Dis 2017; 9 (07) 2029-2037
    CrossrefPubMedGoogle Scholar
  • 24 Liu YW, Chang PC, Chang SJ, Chiang HH, Li HP, Chou SH. Simultaneous bilateral thoracoscopic blebs excision reduces contralateral recurrence in patients undergoing operation for ipsilateral primary spontaneous pneumothorax. J Thorac Cardiovasc Surg 2020; 159 (03) 1120-1127.e3
    CrossrefPubMedGoogle Scholar
  • 25 Xu G, Fu X. One-stage video-assisted thoracic surgery for bilateral multiple pulmonary nodules. J Thorac Dis 2019; 11 (02) 535-541
    CrossrefPubMedGoogle Scholar
  • 26 Huang C, Sun Y, Wu Q. et al. Simultaneous bilateral pulmonary resection via single-utility port VATS for multiple pulmonary nodules: a single-center experience of 16 cases. Thorac Cancer 2021; 12 (04) 525-533
    CrossrefPubMedGoogle Scholar
  • 27 Cho JH, Kim S, Namgung M. et al. The prognostic importance of the number of metastases in pulmonary metastasectomy of colorectal cancer. World J Surg Oncol 2015; 13: 222
    CrossrefPubMedGoogle Scholar
  • 28 Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ. A prospective study of chronic pain after thoracic surgery. Anesthesiology 2017; 126 (05) 938-951
    CrossrefPubMedGoogle Scholar
  • 29 Internullo E, Cassivi SD, Van Raemdonck D, Friedel G, Treasure T. ESTS Pulmonary Metastasectomy Working Group. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol 2008; 3 (11) 1257-1266
    CrossrefPubMedGoogle Scholar
  • 30 Kao CN, Liu YW. Simultaneous bilateral pulmonary metastasectomy: a cost-effective surgery. J Surg Oncol 2022; 125 (02) 310-311
    CrossrefPubMedGoogle Scholar