Progress in surgical treatment of pulmonary metastases_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PENG Dongge ,  SUN Wei

Department of the First Thoracic Surgery, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, 830011, Xinjiang,P. R. China;

Corresponding author：

SUN Wei, Email: 327045057@qq.com

Keywords：

Pulmonary metastases; metastasectomy; prognosis; surgery; review

DOI：

10.7507/1007-4848.202108066

Video：

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Lung is one of the most common metastatic organs of carcinomas. Pulmonary metastasectomy has become a common procedure in thoracic surgery and its effectiveness has been demonstrated by many researches. Once the malignant tumor is combined with lung metastasis, which belongs to the category of advanced tumor, surgical resection is only a palliative treatment to reduce the tumor load. However, there are still some controversies among the surgical indications, preoperative examinations, surgical methods and resection ranges, lymph node management, recurrence and re-resection of metastatic tumor and prognostic factors. This article reviews pulmonary metastasectomy from the above aspects.

Citation： PENG Dongge, SUN Wei. Progress in surgical treatment of pulmonary metastases. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 464-469. doi: 10.7507/1007-4848.202108066 Copy

1.	郑荣寿, 魏文强, 赫捷, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 593-600.
2.	Bartlett EK, Simmons KD, Wachtel H, et al. The rise in metastasectomy across cancer types over the past decade. Cancer, 2015, 121(5): 747-757.
3.	Li Y, Zhang W, Li S, et al. Clinical efficiency of repeated pulmonary metastasectomy in sarcoma patients with recurrent pulmonary metastasis: A meta-analysis. J Cancer Res Ther, 2018, 14(Suppl): S457-S462.
4.	Akın Kabalak P, Kızılgöz D, Yılmaz Ü, et al. Treatment outcomes in oligometastatic non-small-cell lung cancer: A single-centre experience. Clin Respir J, 2020, 14(5): 471-480.
5.	Macherey S, Bruns C, Alakus H, et al. Lung metastasectomy in pulmonary metastatic colorectal carcinoma. Zentralbl Chir, 2018, 143(2): 193-204.
6.	Hübner N, Shariat SF. Palliative surgery for metastatic urothelial cancer. Aktuelle Urol, 2018, 49(5): 412-416.
7.	Pastorino U, Buyse M, Friedel G, et al. Long-term results of lung metastasectomy: Prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg, 1997, 113(1): 37-49.
8.	Dackam S, Ojanguren A, Perentes JY, et al. Pulmonary metastasectomy. Rev Med Suisse, 2019, 15(655): 1221-1225.
9.	Handy JR, Bremner RM, Crocenzi TS, et al. Expert consensus document on pulmonary metastasectomy. Ann Thorac Surg, 2019, 107(3): 631-649.
10.	中国医师协会外科医师分会多学科综合治疗专业委员会, 中国抗癌协会大肠癌专业委员会. 结直肠癌肺转移多学科综合治疗专家共识(2018 版). 中国肿瘤临床, 2019, 107(3): 631-649.
11.	Milosevic M, Edwards J, Tsang D, et al. Pulmonary metastasectomy in colorectal cancer: Updated analysis of 93 randomized patients—Control survival is much better than previously assumed. Colorectal Dis, 2020, 22(10): 1314-1324.
12.	Paget S. The distribution of secondary growths in cancer of the breast. 1889. Cancer Metastasis Rev, 1989, 8(2): 98-101.
13.	Gupta GP, Massagué J. Cancer metastasis: Building a framework. Cell, 2006, 127(4): 679-695.
14.	Dingemans AC, Hendriks LEL, Berghmans T, et al. Definition of synchronous oligometastatic non-small cell lung cancer-A consensus report. J Thorac Oncol, 2019, 14(12): 2109-2119.
15.	Shiono S, Matsutani N, Okumura S, et al. The prognostic impact of lymph-node dissection on lobectomy for pulmonary metastasis. Eur J Cardiothorac Surg, 2015, 48(4): 616-621.
16.	中国肺癌防治联盟, 中华医学会呼吸病学分会肺癌学组, 中国医师协会呼吸医师分会肺癌工作委员会. 肺癌筛查与管理中国专家共识. 国际呼吸杂志, 2019, 39(21): 1604-1615.
17.	Taralli S, Scolozzi V, Foti M, et al. 18 F-FDG PET/CT diagnostic performance in solitary and multiple pulmonary nodules detected in patients with previous cancer history: Reports of 182 nodules. Eur J Nucl Med Mol Imaging, 2019, 46(2): 429-436.
18.	Cheung FP, Alam NZ, Wright GM. The past, present and future of pulmonary metastasectomy: A review article. Ann Thorac Cardiovasc Surg, 2019, 25(3): 129-141.
19.	Zabaleta J, Iida T, Falcoz PE, et al. Individual data meta-analysis for the study of survival after pulmonary metastasectomy in colorectal cancer patients: A history of resected liver metastases worsens the prognosis. Eur J Surg Oncol, 2018, 44(7): 1006-1012.
20.	闫崴, 韩翔, 何萍, 等. 超声支气管镜下穿刺活检对纵隔、肺门淋巴结肿块的诊疗研究. 中国超声医学杂志, 2016, 32(2): 127-130.
21.	Macherey S, Doerr F, Heldwein M, et al. Is manual palpation of the lung necessary in patients undergoing pulmonary metastasectomy? Interact Cardiovasc Thorac Surg, 2016, 22(3): 351-359.
22.	Gonzalez M, Brunelli A, Szanto Z, et al. Report from the European Society of Thoracic Surgeons database 2019: Current surgical practice and perioperative outcomes of pulmonary metastasectomy. Eur J Cardiothorac Surg, 2021, 59(5): 996-1003.
23.	Cheung F, Alam N, Wright G. Pulmonary metastasectomy: Analysis of survival and prognostic factors in 243 patients. ANZ J Surg, 2018, 88(12): 1316-1321.
24.	高树庚, 邱斌, 郭晓彤, 等. 胸腔镜解剖性部分肺叶切除手术技巧. 中华胸部外科电子杂志, 2016, 3(2): 122-124.
25.	Shiono S, Okumura T, Boku N, et al. Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg, 2017, 51(3): 504-510.
26.	Londero F, Morelli A, Parise O, et al. Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence. J Surg Oncol, 2019, 120(4): 768-778.
27.	Internullo E, Cassivi SD, Van Raemdonck D, et al. Pulmonary metastasectomy: A survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol, 2008, 3(11): 1257-1266.
28.	Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: Initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg, 2006, 81(3): 1013-1019.
29.	Menna C, Berardi G, Tierno SM, et al. Do repeated operations for recurrent colorectal lung metastases result in improved survival? Ann Thorac Surg, 2018, 106(2): 421-427.
30.	Forster C, Ojanguren A, Perentes JY, et al. Is repeated pulmonary metastasectomy justified? Clin Exp Metastasis, 2020, 37(6): 675-682.
31.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
32.	Jones GD, Lengel HB, Hsu M, et al. Management of synchronous extrathoracic oligometastatic non-small cell lung cancer. Cancers (Basel), 2021, 13(8): 1893.
33.	Hanna N, Johnson D, Temin S, et al. Systemic therapy for stage Ⅳ non-small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2017, 35(30): 3484-3515.
34.	Wang Z, Wang X, Yuan J, et al. Survival benefit of palliative local treatments and efficacy of different pharmacotherapies in colorectal cancer with lung metastasis: Results from a large retrospective study. Clin Colorectal Cancer, 2018, 17(2): e233-e255.
35.	Gonzalez M, Poncet A, Combescure C, et al. Risk factors for survival after lung metastasectomy in colorectal cancer patients: A systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(2): 572-579.
36.	Rapicetta C, Lococo F, Davini F, et al. Is adjuvant chemotherapy worthwhile after radical resection for single lung metastasis from colorectal cancer? A multicentric analysis evaluating the risk of recurrence. Front Oncol, 2019, 9: 763.
37.	Chudgar NP, Brennan MF, Munhoz RR, et al. Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma. J Thorac Cardiovasc Surg, 2017, 154(1): 319-330.
38.	Digesu CS, Wiesel O, Vaporciyan AA, et al. Management of sarcoma metastases to the lung. Surg Oncol Clin N Am, 2016, 25(4): 721-733.
39.	Yamamoto Y, Kanzaki R, Kanou T, et al. Long-term outcomes and prognostic factors of pulmonary metastasectomy for osteosarcoma and soft tissue sarcoma. Int J Clin Oncol, 2019, 24(7): 863-870.
40.	康晓征, 闫万璞, 杨永波, 等. 骨与软组织肉瘤肺转移的单中心大样本外科治疗结果及预后分析. 中国肺癌杂志, 2016, 19(5): 299-306.
41.	Petrella F, Diotti C, Rimessi A, et al. Pulmonary metastasectomy: An overview. J Thorac Dis, 2017, 9(Suppl 12): S1291-S1298.
42.	Endoh M, Shiono S, Yamauchi Y, et al. Pulmonary metastasectomy for pulmonary metastasis of breast cancer has a limited prognostic impact: A multi-institutional retrospective analysis. J Thorac Dis, 2020, 12(11): 6552-6562.
43.	Fan J, Chen D, Du H, et al. Prognostic factors for resection of isolated pulmonary metastases in breast cancer patients: A systematic review and meta-analysis. J Thorac Dis, 2015, 7(8): 1441-1451.
44.	Macherey S, Mallmann P, Malter W, et al. Lung metastasectomy for pulmonary metastatic breast carcinoma. Geburtshilfe Frauenheilkd, 2017, 77(6): 645-650.
45.	Bilani N, Elson L, Liang H, et al. Effect of surgery at primary and metastatic sites in patients with stage Ⅳ breast cancer. Clin Breast Cancer, 2021, 21(3): 170-180.
46.	Paik ES, Yoon A, Lee YY, et al. Pulmonary metastasectomy in uterine malignancy: Outcomes and prognostic factors. J Gynecol Oncol, 2015, 26(4): 270-276.
47.	Hacker NF, Rao A. Surgical management of lung, liver and brain metastases from gynecological cancers: A literature review. Gynecol Oncol Res Pract, 2016, 3: 7.
48.	Adachi M, Mizuno M, Mitsui H, et al. The prognostic impact of pulmonary metastasectomy in recurrent gynecologic cancers: A retrospective single-institution study. Nagoya J Med Sci, 2015, 77(3): 363-372.
49.	Anile M, Mantovani S, Pecoraro Y, et al. Pulmonary metastasectomy in uterine malignancies: Outcome and prognostic factors. J Thorac Dis, 2017, 9(Suppl 12): S1273-S1277.

1. 郑荣寿, 魏文强, 赫捷, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 593-600.
2. Bartlett EK, Simmons KD, Wachtel H, et al. The rise in metastasectomy across cancer types over the past decade. Cancer, 2015, 121(5): 747-757.
3. Li Y, Zhang W, Li S, et al. Clinical efficiency of repeated pulmonary metastasectomy in sarcoma patients with recurrent pulmonary metastasis: A meta-analysis. J Cancer Res Ther, 2018, 14(Suppl): S457-S462.
4. Akın Kabalak P, Kızılgöz D, Yılmaz Ü, et al. Treatment outcomes in oligometastatic non-small-cell lung cancer: A single-centre experience. Clin Respir J, 2020, 14(5): 471-480.
5. Macherey S, Bruns C, Alakus H, et al. Lung metastasectomy in pulmonary metastatic colorectal carcinoma. Zentralbl Chir, 2018, 143(2): 193-204.
6. Hübner N, Shariat SF. Palliative surgery for metastatic urothelial cancer. Aktuelle Urol, 2018, 49(5): 412-416.
7. Pastorino U, Buyse M, Friedel G, et al. Long-term results of lung metastasectomy: Prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg, 1997, 113(1): 37-49.
8. Dackam S, Ojanguren A, Perentes JY, et al. Pulmonary metastasectomy. Rev Med Suisse, 2019, 15(655): 1221-1225.
9. Handy JR, Bremner RM, Crocenzi TS, et al. Expert consensus document on pulmonary metastasectomy. Ann Thorac Surg, 2019, 107(3): 631-649.
10. 中国医师协会外科医师分会多学科综合治疗专业委员会, 中国抗癌协会大肠癌专业委员会. 结直肠癌肺转移多学科综合治疗专家共识(2018 版). 中国肿瘤临床, 2019, 107(3): 631-649.
11. Milosevic M, Edwards J, Tsang D, et al. Pulmonary metastasectomy in colorectal cancer: Updated analysis of 93 randomized patients—Control survival is much better than previously assumed. Colorectal Dis, 2020, 22(10): 1314-1324.
12. Paget S. The distribution of secondary growths in cancer of the breast. 1889. Cancer Metastasis Rev, 1989, 8(2): 98-101.
13. Gupta GP, Massagué J. Cancer metastasis: Building a framework. Cell, 2006, 127(4): 679-695.
14. Dingemans AC, Hendriks LEL, Berghmans T, et al. Definition of synchronous oligometastatic non-small cell lung cancer-A consensus report. J Thorac Oncol, 2019, 14(12): 2109-2119.
15. Shiono S, Matsutani N, Okumura S, et al. The prognostic impact of lymph-node dissection on lobectomy for pulmonary metastasis. Eur J Cardiothorac Surg, 2015, 48(4): 616-621.
16. 中国肺癌防治联盟, 中华医学会呼吸病学分会肺癌学组, 中国医师协会呼吸医师分会肺癌工作委员会. 肺癌筛查与管理中国专家共识. 国际呼吸杂志, 2019, 39(21): 1604-1615.
17. Taralli S, Scolozzi V, Foti M, et al. 18 F-FDG PET/CT diagnostic performance in solitary and multiple pulmonary nodules detected in patients with previous cancer history: Reports of 182 nodules. Eur J Nucl Med Mol Imaging, 2019, 46(2): 429-436.
18. Cheung FP, Alam NZ, Wright GM. The past, present and future of pulmonary metastasectomy: A review article. Ann Thorac Cardiovasc Surg, 2019, 25(3): 129-141.
19. Zabaleta J, Iida T, Falcoz PE, et al. Individual data meta-analysis for the study of survival after pulmonary metastasectomy in colorectal cancer patients: A history of resected liver metastases worsens the prognosis. Eur J Surg Oncol, 2018, 44(7): 1006-1012.
20. 闫崴, 韩翔, 何萍, 等. 超声支气管镜下穿刺活检对纵隔、肺门淋巴结肿块的诊疗研究. 中国超声医学杂志, 2016, 32(2): 127-130.
21. Macherey S, Doerr F, Heldwein M, et al. Is manual palpation of the lung necessary in patients undergoing pulmonary metastasectomy? Interact Cardiovasc Thorac Surg, 2016, 22(3): 351-359.
22. Gonzalez M, Brunelli A, Szanto Z, et al. Report from the European Society of Thoracic Surgeons database 2019: Current surgical practice and perioperative outcomes of pulmonary metastasectomy. Eur J Cardiothorac Surg, 2021, 59(5): 996-1003.
23. Cheung F, Alam N, Wright G. Pulmonary metastasectomy: Analysis of survival and prognostic factors in 243 patients. ANZ J Surg, 2018, 88(12): 1316-1321.
24. 高树庚, 邱斌, 郭晓彤, 等. 胸腔镜解剖性部分肺叶切除手术技巧. 中华胸部外科电子杂志, 2016, 3(2): 122-124.
25. Shiono S, Okumura T, Boku N, et al. Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg, 2017, 51(3): 504-510.
26. Londero F, Morelli A, Parise O, et al. Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence. J Surg Oncol, 2019, 120(4): 768-778.
27. Internullo E, Cassivi SD, Van Raemdonck D, et al. Pulmonary metastasectomy: A survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol, 2008, 3(11): 1257-1266.
28. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: Initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg, 2006, 81(3): 1013-1019.
29. Menna C, Berardi G, Tierno SM, et al. Do repeated operations for recurrent colorectal lung metastases result in improved survival? Ann Thorac Surg, 2018, 106(2): 421-427.
30. Forster C, Ojanguren A, Perentes JY, et al. Is repeated pulmonary metastasectomy justified? Clin Exp Metastasis, 2020, 37(6): 675-682.
31. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
32. Jones GD, Lengel HB, Hsu M, et al. Management of synchronous extrathoracic oligometastatic non-small cell lung cancer. Cancers (Basel), 2021, 13(8): 1893.
33. Hanna N, Johnson D, Temin S, et al. Systemic therapy for stage Ⅳ non-small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2017, 35(30): 3484-3515.
34. Wang Z, Wang X, Yuan J, et al. Survival benefit of palliative local treatments and efficacy of different pharmacotherapies in colorectal cancer with lung metastasis: Results from a large retrospective study. Clin Colorectal Cancer, 2018, 17(2): e233-e255.
35. Gonzalez M, Poncet A, Combescure C, et al. Risk factors for survival after lung metastasectomy in colorectal cancer patients: A systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(2): 572-579.
36. Rapicetta C, Lococo F, Davini F, et al. Is adjuvant chemotherapy worthwhile after radical resection for single lung metastasis from colorectal cancer? A multicentric analysis evaluating the risk of recurrence. Front Oncol, 2019, 9: 763.
37. Chudgar NP, Brennan MF, Munhoz RR, et al. Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma. J Thorac Cardiovasc Surg, 2017, 154(1): 319-330.
38. Digesu CS, Wiesel O, Vaporciyan AA, et al. Management of sarcoma metastases to the lung. Surg Oncol Clin N Am, 2016, 25(4): 721-733.
39. Yamamoto Y, Kanzaki R, Kanou T, et al. Long-term outcomes and prognostic factors of pulmonary metastasectomy for osteosarcoma and soft tissue sarcoma. Int J Clin Oncol, 2019, 24(7): 863-870.
40. 康晓征, 闫万璞, 杨永波, 等. 骨与软组织肉瘤肺转移的单中心大样本外科治疗结果及预后分析. 中国肺癌杂志, 2016, 19(5): 299-306.
41. Petrella F, Diotti C, Rimessi A, et al. Pulmonary metastasectomy: An overview. J Thorac Dis, 2017, 9(Suppl 12): S1291-S1298.
42. Endoh M, Shiono S, Yamauchi Y, et al. Pulmonary metastasectomy for pulmonary metastasis of breast cancer has a limited prognostic impact: A multi-institutional retrospective analysis. J Thorac Dis, 2020, 12(11): 6552-6562.
43. Fan J, Chen D, Du H, et al. Prognostic factors for resection of isolated pulmonary metastases in breast cancer patients: A systematic review and meta-analysis. J Thorac Dis, 2015, 7(8): 1441-1451.
44. Macherey S, Mallmann P, Malter W, et al. Lung metastasectomy for pulmonary metastatic breast carcinoma. Geburtshilfe Frauenheilkd, 2017, 77(6): 645-650.
45. Bilani N, Elson L, Liang H, et al. Effect of surgery at primary and metastatic sites in patients with stage Ⅳ breast cancer. Clin Breast Cancer, 2021, 21(3): 170-180.
46. Paik ES, Yoon A, Lee YY, et al. Pulmonary metastasectomy in uterine malignancy: Outcomes and prognostic factors. J Gynecol Oncol, 2015, 26(4): 270-276.
47. Hacker NF, Rao A. Surgical management of lung, liver and brain metastases from gynecological cancers: A literature review. Gynecol Oncol Res Pract, 2016, 3: 7.
48. Adachi M, Mizuno M, Mitsui H, et al. The prognostic impact of pulmonary metastasectomy in recurrent gynecologic cancers: A retrospective single-institution study. Nagoya J Med Sci, 2015, 77(3): 363-372.
49. Anile M, Mantovani S, Pecoraro Y, et al. Pulmonary metastasectomy in uterine malignancies: Outcome and prognostic factors. J Thorac Dis, 2017, 9(Suppl 12): S1273-S1277.

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