Tomohiro Murakawa1, Hajime Sato2, Sakae Okumura3, Jun Nakajima1, Hirotoshi Horio4, Yuichi Ozeki5, Hisao Asamura6, Norihiko Ikeda7, Hajime Otsuka8, Haruhisa Matsuguma9, Ichiro Yoshino10, Masayuki Chida11, Mitsuo Nakayama12, Toshihiko Iizasa13, Meinoshin Okumura14, Satoshi Shiono15, Ryoichi Kato16, Tomohiko Iida17, Noriyuki Matsutani18, Masafumi Kawamura18, Yukinori Sakao19, Kazuhito Funai20, Go Furuyashiki21, Hirohiko Akiyama22, Shigeki Sugiyama23, Naoki Kanauchi24, Yuji Shiraishi25. 1. Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. 2. Department of Health Policy and Technology Assessment, National Institute of Public Health, Saitama, Japan. 3. Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 4. Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 5. Department of Thoracic Surgery, National Defense Medical College, Saitama, Japan. 6. Department of General Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan. 7. First Department of Surgery, Tokyo Medical University, Tokyo, Japan. 8. Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan. 9. Division of Thoracic Surgery, Tochigi Cancer Center, Tochigi, Japan. 10. Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. 11. Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan. 12. Department of General Thoracic Surgery, Saitama Medical Center, Saitama, Japan. 13. Department of Thoracic Surgery, Chiba Caner Center, Chiba. 14. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 15. Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan. 16. Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. 17. Department of Thoracic Surgery, Kimitsu Central Hospital, Chiba, Japan. 18. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 19. Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan. 20. First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan. 21. Department of Thoracic Surgery, Nagaoka Chuo General Hospital, Niigata, Japan. 22. Department of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan. 23. Respiratory Department, Tomei Atsugi Hospital, Kanagawa, Japan. 24. Department of General Thoracic Surgery, Nihonkai General Hospital, Yamagata, Japan. 25. Section of Chest Surgery, Fukujuji Hospital, Tokyo, Japan.
Abstract
OBJECTIVES: Thoracoscopic surgery for lung metastasectomy remains controversial. The study aimed at determining the efficacy of thoracoscopic surgery for lung metastasectomy. METHODS: This was a multi-institutional, retrospective study that included 1047 patients who underwent lung metastasectomy for colorectal cancer between 1999 and 2014. Prognostic factors of overall survival were compared between the thoracoscopic and open thoracotomy groups using the multivariate Cox proportional hazard model. The propensity score, calculated using the preoperative covariates, included the era of lung surgery as a covariate. A stepwise backward elimination method, with a probability level of 0.15, was used to select the most powerful sets of outcome predictors. The difference between the radiological tumour number and the resected tumour number (delta_num) was also evaluated. RESULTS: The c -statistics and the P -value of the Hosmer-Lemeshow Chi-square of the propensity score model were 0.7149 and 0.1579, respectively. After adjusting for the propensity score, the thoracoscopy group had a better survival rate than the open group (stratified log-rank test: P = 0.0353). After adjusting for the propensity score, the most powerful predictive model for overall survival was that which combined thoracoscopy [hazard ratio (HR): 0.468, 95% CI: 0.262-0.838, P = 0.011] and anatomical resection (HR: 1.49, 95% CI: 1.134-1.953, P = 0.004). Before adjusting for the propensity score, the delta_num was significantly greater in the open group than in the thoracoscopy group (thoracoscopy: 0.06, open: 0.33, P = 0.001); however, after adjustment, there was no difference in the delta_num (thoracoscopy: 0.04, open: 0.19, P = 0.114). CONCLUSIONS: Thoracoscopic metastasectomy showed better overall survival than the open approach in this analysis. The thoracoscopic approach may be an acceptable option for resection of pulmonary metastases in terms of tumour identification and survival outcome in the current era.
OBJECTIVES: Thoracoscopic surgery for lung metastasectomy remains controversial. The study aimed at determining the efficacy of thoracoscopic surgery for lung metastasectomy. METHODS: This was a multi-institutional, retrospective study that included 1047 patients who underwent lung metastasectomy for colorectal cancer between 1999 and 2014. Prognostic factors of overall survival were compared between the thoracoscopic and open thoracotomy groups using the multivariate Cox proportional hazard model. The propensity score, calculated using the preoperative covariates, included the era of lung surgery as a covariate. A stepwise backward elimination method, with a probability level of 0.15, was used to select the most powerful sets of outcome predictors. The difference between the radiological tumour number and the resected tumour number (delta_num) was also evaluated. RESULTS: The c -statistics and the P -value of the Hosmer-Lemeshow Chi-square of the propensity score model were 0.7149 and 0.1579, respectively. After adjusting for the propensity score, the thoracoscopy group had a better survival rate than the open group (stratified log-rank test: P = 0.0353). After adjusting for the propensity score, the most powerful predictive model for overall survival was that which combined thoracoscopy [hazard ratio (HR): 0.468, 95% CI: 0.262-0.838, P = 0.011] and anatomical resection (HR: 1.49, 95% CI: 1.134-1.953, P = 0.004). Before adjusting for the propensity score, the delta_num was significantly greater in the open group than in the thoracoscopy group (thoracoscopy: 0.06, open: 0.33, P = 0.001); however, after adjustment, there was no difference in the delta_num (thoracoscopy: 0.04, open: 0.19, P = 0.114). CONCLUSIONS: Thoracoscopic metastasectomy showed better overall survival than the open approach in this analysis. The thoracoscopic approach may be an acceptable option for resection of pulmonary metastases in terms of tumour identification and survival outcome in the current era.
Authors: Marco Sperandeo; Elisabettamaria Frongillo; Lucia Maria Cecilia Dimitri; Anna Simeone; Salvatore De Cosmo; Marco Taurchini; Cristiana Cipriani Journal: J Ultrasound Date: 2019-03-23