Thoracoscopic resection of solitary lung metastases evaluated by using thin-section chest computed tomography: is thoracoscopic surgery still a valid option?

OBJECTIVE: This study evaluated long-term outcomes of pulmonary metastasectomy for solitary lung metastases to clarify the role of video-assisted thoracoscopic surgery in the selected population.
METHODS: We retrospectively investigated oncologic results after the resection of solitary lung metastases guided by thin-section chest computed tomography scans in 105 patients. Pulmonary metastasectomy for solitary lung metastases was approached by thoracotomy (n = 43) and by thoracoscopy (n = 62).
RESULTS: Compared to the thoracotomy group, the thoracoscopy group had a shorter hospital stay (p < 0.001) postoperatively. Intrathoracic recurrence developed in 11 (25.6 %) patients in the thoracotomy group and 15 (24.2 %) in the thoracoscopy group. 19 patients (18.1 %) underwent re-metastasectomy during the median 36-month (5-113) follow-up (p = 0.693). Re-metastasectomy was performed in 8 patients (18.6 %) in the thoracotomy group and in 11 patients (17.7 %) in the thoracoscopy group (p = 0.910). Overall survival was not significantly different between the two groups (p = 0.210). Intrathoracic recurrence was the only significant risk factor for overall survival (p = 0.036) in multivariate analysis.
CONCLUSIONS: In a highly selected group with solitary lung metastases, pulmonary metastasectomy by thoracotomy or thoracoscopy did not affect survival. There were comparable oncologic results from both surgeries when applied in solitary lung metastases from an extra-thoracic malignancy. Thoracoscopic metastasectomy is a promising option in small, solitary pulmonary metastases.