Video-assisted thoracic surgery (VATS) for resection of metastatic adenocarcinoma as an acceptable alternative

Marilee Carballo, Mary S. Maish, Dawn E. Jaroszewski, Amy Yetasook, Karl Bauer, Robert B. Cameron, E. Carmack Holmes

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Abstract

Background Adenocarcinomas commonly metastasize to the lungs and can be resected using open thoracotomy or video-assisted thoracic surgery (VATS). This study reviews metastatic resections in primary adenocarcinoma patients, using both thoracotomy and VATS. We aim to compare long-term prognoses to test the efficacy and viability of VATS. Methods A retrospective review of primary adenocarcinoma patients who underwent resection of pulmonary metastases from 1990 to 2006 was carried out. Information was obtained by chart review. Endpoints analyzed were disease-free interval (DFI), survival time, and recurrencefree survival (RFS). Results In a total of 42 (16 male, 26 female; median age 58.5 years) primary adenocarcinoma patients, 21 patients underwent first pulmonary metastatic resection using VATS (7 male, 14 female; median age 57 years) and 21 using thoracotomy (9 male, 12 female; median age 59 years). Primary adenocarcinomas were mainly 27 colorectal (64%) and 11 breast (26%). Two VATS (10%) and three open patients (14%) had local recurrences of the original cancer. Median postoperative follow was 13.3 months [interquartile range (IQR) 4.5-32.8 months] for VATS and 36.9 months (IQR 19.3-48.6 months) after thoracotomy. Median DFI-1 was 22.3 months (IQR 13.5-40.6 months) forVATSpatients and 35.6 months (IQR 26.7-61.3 months) for open patients. Second thoracic occurrences were noted in six VATS patients (median DFI-2 9.2 months), and in seven open patients (median DFI-2 21.5 months). Third thoracic occurrences were noted in one VATS patient (DFI-3 18.7 months) and in one thoracotomy patient (DFI-3 21.8 months). Odds ratio of recurrence showed 12.5% less chance of developing recurrence in VATS patients. Five-year RFS was 53% in VATS and 57% in thoracotomy patients. Conclusions VATS has become a viable alternative to open thoracotomy for resection of pulmonary metastases. In cases of primary adenocarcinoma, VATS showed no increase in number of thoracic recurrences, and comparable RFS. Short-term follow-up is encouraging; long-term follow- up will be needed to confirm these results.

Original languageEnglish (US)
Pages (from-to)1947-1954
Number of pages8
JournalSurgical endoscopy
Volume23
Issue number9
DOIs
StatePublished - Sep 2009

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Keywords

  • Adenocarcinoma
  • Cancer
  • Pulmonary metastases
  • Thoracoscopy
  • Thoracotomy
  • VATS

ASJC Scopus subject areas

  • Surgery

Cite this

Carballo, M., Maish, M. S., Jaroszewski, D. E., Yetasook, A., Bauer, K., Cameron, R. B., & Carmack Holmes, E. (2009). Video-assisted thoracic surgery (VATS) for resection of metastatic adenocarcinoma as an acceptable alternative. Surgical endoscopy, 23(9), 1947-1954. https://doi.org/10.1007/s00464-008-0243-z