Prognostic factors of oligometastatic non-small-cell lung cancer following radical therapy: a multicentre analysis

OBJECTIVES Patients with oligometastatic non-small-cell lung cancer (NSCLC) may benefit from therapy with curative intent. Our goal was to identify prognostic factors related to better prognosis in a multicentre analysis of patients who underwent surgery of primary tumours in combination with radical treatment of all metastatic sites. METHODS We retrospectively reviewed the records of oligometastatic patients who underwent resection of primary tumours at 4 centres (August 2001-February 2018). Oligometastasis was defined as ≤5 synchronous metastases in ≤2 organs. Radical metastatic treatment was surgery, radiotherapy or a combination. The Cox proportional hazards model was used for identification of prognostic factors on overall survival. RESULTS We treated 124 patients; 72 (58%) were men, mean age 60 ± 9.8 years, with 87 (70%) adenocarcinoma. Sixty-seven (54%) patients had positive pathologic-N stage (pN). Brain metastases were most common (n = 76; 61%) followed by adrenal (n = 13; 10%) and bone (n = 12; 10%). Systemic therapy was administered in 101 (82%) patients. Median follow-up was 60 months [95% confidence interval (CI) 41-86]. Thirty- and 90-day mortality rates were 0 and 2.4%, respectively. One-, 2-, and 5-year overall survival were 80%, 58% and 36%, respectively. Cox regression analysis showed that patients ≤60 years [hazard ratio (HR) 0.41, 95% CI 0.24, 0.69; P = 0.001] and patients with pN0 (HR 0.38, 95% CI 0.21-0.69; P = 0.002) had a significant survival benefit. The presence of bone metastases negatively affected survival (HR 2.53, 95% CI 1.05-6.09; P = 0.04). CONCLUSIONS Treatment with curative intent of selected oligometastatic NSCLC, including resection of the primary tumour, can be performed safely and with excellent 5-year survival rates, especially in younger patients with pN0 disease

Métastases pulmonaires : une maladie chirurgicale ?

Au cours d’un cancer, 40 % des patients vont développer des métastases pulmonaires et dans cette situation un traitement seul de chimiothérapie est généralement peu efficace. Même s’il n’existe pas d’études randomisées prospectives qui confirment le bénéfice de la métastasectomie pulmonaire chirurgicale, diverses études ont montré l’existence d’un groupe de patients atteints de métastases pulmonaires qui bénéficient d’une résection à visée curative en cas de résection complète des métastases pulmonaires. Différentes approches chirurgicales peuvent être utilisées ayant pour but principal une résection complète et une épargne maximale du parenchyme pulmonaire. Les approches minimales invasives semblent offrir une meilleure qualité de vie et un résultat oncologique équivalent à l’approche par voie ouvert

Impact of complex segmentectomies by video-assisted thoracic surgery on peri-operative outcomes

Pulmonary segmentectomies are generally classified into simple (tri-segmentectomy or lingulectomy as well as apical or basilar segmentectomy) and complex (individual or bi-segmentectomy of the upper, middle and lower lobes). Complex segmentectomies are technically feasible by video-assisted thoracic surgery (VATS) but remain challenging, and reports on post-operative outcomes are scarce. This study analyzes the differences between simple and complex VATS segmentectomy in terms of peri- and post-operative outcomes

Metachronous lung cancer resection on extracorporeal membrane oxygenation in a pneumonectomized and mediastinum irradiated patient

The management of localized, metachronous, primary non-small cell lung cancer (MP-NSCLC) in pneumonectomized patients is challenging. It generally consists in stereotactic radiation therapy. We report the case of a 57-year-old patient who had a prior history of left pneumonectomy and mediastinal irradiation to manage a central stage IIIA NSCLC. He developed a MP-NSCLC in the middle lobe after 6 years. Stereotactic radiation was judged too risky because of the cumulative dose to the heart and risk of pneumonitis. Pulmonary functions and the cardiovascular evaluation were normal. Multidisciplinary discussions suggested a local treatment for this lesion. The patient underwent a thoracoscopic middle lobe lateral segmentectomy on veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. The patient was extubated and weaned from the ECMO at the end of the case and stayed 24 h at the intensive care unit for surveillance. He was discharged from the hospital on day 4. The histopathological analysis revealed a moderately differentiated NSCLC that was completely resected with no lymph node invasion (pT1N0L0V0Pn0R0). Twenty-four months after surgery, the patient is alive and disease free. Management of MP-NSCLC in pneumonectomized patients is challenging and should be tailored to each individual case. Extracorporeal life support has helped push the boundaries of patient operability thus extending survival for patients that could previously not be considered for surgery

Performance of prolonged air leak scoring systems in patients undergoing video-assisted thoracoscopic surgery segmentectomy

Objectives: We assessed the accuracy of 3 validated lobectomy scoring systems to predict prolonged air leak (PAL) in patients undergoing video-assisted thoracoscopic surgery (VATS) segmentectomy. Methods: We reviewed all consecutive patients who had a VATS segmentectomy between January 2016 and October 2020. We determined PALs on postoperative day 5. These findings were correlated with the calculated Brunelli (gender, age, body mass index [BMI], forced expiratory volume in 1 s 5 days following the VATS segmentectomies. ESTS scores seem easier to introduce in clinical practice, but validation by a multicentre cohort is mandatory

CT-Derived Sarcopenia and Outcomes after Thoracoscopic Pulmonary Resection for Non-Small Cell Lung Cancer

We aimed to evaluate whether computed tomography (CT)-derived preoperative sarcopenia measures were associated with postoperative outcomes and survival after video-assisted thoracoscopic (VATS) anatomical pulmonary resection in patients with early-stage non-small cell lung cancer (NSCLC). We retrospectively reviewed all consecutive patients that underwent VATS anatomical pulmonary resection for NSCLC between 2012 and 2019. Skeletal muscle mass was measured at L3 vertebral level on preoperative CT or PET/CT scans to identify sarcopenic patients according to established threshold values. We compared postoperative outcomes and survival of sarcopenic vs. non-sarcopenic patients. A total of 401 patients underwent VATS anatomical pulmonary resection for NSCLC. Sarcopenia was identified in 92 patients (23%). Sarcopenic patients were predominantly males (75% vs. 25%; p 2; p p = 0.017) in sarcopenic patients and the length of hospital stay was prolonged (8 vs. 6 days; p = 0.032). Two factors were associated with postoperative morbidity in multivariate analysis: BMI and American Society of Anesthesiologists score >2. Median overall survival was comparable between groups (41 vs. 46 months; p = 0.240). CT-derived sarcopenia appeared to have a small impact on early postoperative clinical outcomes, but no effect on overall survival after VATS anatomical lung resection for NSCLC