BACKGROUND: Previous data suggest a survival benefit in well selected patients with extrathoracic sarcoma after pulmonary metastasectomy. Different techniques have been described for pulmonary metastasectomy; however laser-assisted surgery (LAS) was suggested to provide the best outcome in patients with higher numbers of metastases. METHODS: Data were extracted from a prospectively maintained institutional database and a total of 83 patients who underwent pulmonary metastasectomy at our clinic in the last 11 years were identified. RESULTS: We analyzed a total of 106 operations of which LAS was performed in 46 and conventional resection in 60 cases. Significantly more metastases were resected in the LAS group compared to the conventional group [median, interquartile range (IQR): 6.5 (2.0-11.0) vs. 1.0 (1.0-3.5); P<0.0001]. Despite this difference the number of tumor recurrences was similar in both groups [64% tumor recurrences in the LAS group and 58% in the conventional group, odds ratio (OR) =1.3, P=0.6]. Furthermore, overall survival (OS) was comparable with a median survival of 77.6 and 29.0 months and 2- and 5-year survival rates of 71% and 63% as well as 53% and 36% in the respective cohorts [hazard ratio (HR) =0.74, P=0.43]. CONCLUSIONS: Using LAS a significantly higher number of metastases were removed while producing similar long-term results as compared to patients treated by other techniques. Expectably, recurrence rates in metastasized sarcoma patients remain high with either surgical method. Future studies will have to evaluate possible advantages provided by LAS in a prospective manner.
BACKGROUND: Previous data suggest a survival benefit in well selected patients with extrathoracic sarcoma after pulmonary metastasectomy. Different techniques have been described for pulmonary metastasectomy; however laser-assisted surgery (LAS) was suggested to provide the best outcome in patients with higher numbers of metastases. METHODS: Data were extracted from a prospectively maintained institutional database and a total of 83 patients who underwent pulmonary metastasectomy at our clinic in the last 11 years were identified. RESULTS: We analyzed a total of 106 operations of which LAS was performed in 46 and conventional resection in 60 cases. Significantly more metastases were resected in the LAS group compared to the conventional group [median, interquartile range (IQR): 6.5 (2.0-11.0) vs. 1.0 (1.0-3.5); P<0.0001]. Despite this difference the number of tumor recurrences was similar in both groups [64% tumor recurrences in the LAS group and 58% in the conventional group, odds ratio (OR) =1.3, P=0.6]. Furthermore, overall survival (OS) was comparable with a median survival of 77.6 and 29.0 months and 2- and 5-year survival rates of 71% and 63% as well as 53% and 36% in the respective cohorts [hazard ratio (HR) =0.74, P=0.43]. CONCLUSIONS: Using LAS a significantly higher number of metastases were removed while producing similar long-term results as compared to patients treated by other techniques. Expectably, recurrence rates in metastasized sarcoma patients remain high with either surgical method. Future studies will have to evaluate possible advantages provided by LAS in a prospective manner.
Authors: U Pastorino; M Buyse; G Friedel; R J Ginsberg; P Girard; P Goldstraw; M Johnston; P McCormack; H Pass; J B Putnam Journal: J Thorac Cardiovasc Surg Date: 1997-01 Impact factor: 5.209
Authors: Samuel Kim; Harald C Ott; Cameron D Wright; John C Wain; Christopher Morse; Henning A Gaissert; Dean M Donahue; Douglas J Mathisen; Michael Lanuti Journal: Ann Thorac Surg Date: 2011-10-31 Impact factor: 4.330
Authors: Carlos E García Franco; Wenceslao Torre; Akiko Tamura; Francisco Guillén-Grima; Mikel San-Julian; Salvador Martin-Algarra; Francisco J Pardo Journal: Eur J Cardiothorac Surg Date: 2009-12-22 Impact factor: 4.191
Authors: K Franzke; R Natanov; N Zinne; T K Rajab; C Biancosino; I Zander; S Lodziewski; M Ricklefs; I Kropivnitskaya; J D Schmitto; A Haverich; M Krüger Journal: Eur J Surg Oncol Date: 2016-09-29 Impact factor: 4.424
Authors: Joachim Pfannschmidt; Gerlinde Egerer; Marc Bischof; Michael Thomas; Hendrik Dienemann Journal: Dtsch Arztebl Int Date: 2012-10-05 Impact factor: 5.594