Survival and Local Recurrence After Video-Assisted Thoracoscopic Lung Metastasectomy.

Background: Pulmonary metastasectomy is increasingly performed in selected patients by video-assisted thoracic surgery (VATS) on the base of thin-slice high-resolution CT-Scan (HRCT). This study determines the overall survival and ipsilateral recurrence rate and of patients undergoing after VATS lung metastasectomy. Patients and method: Retrospective single institution study of all patients who underwent VATS pulmonary metastasectomy on the base of HRCT with curative intent between 2005 and 2014. Results: Seventy-seven patients (41 males, 36 females) underwent VATS pulmonary metastasectomy for solitary ( n = 63) or multiple ( n = 14) lung metastases in the context of colorectal carcinoma ( n = 26), sarcoma ( n = 17), melanoma ( n = 16), or other primaries ( n = 18). Nine patients had bilateral lung metastases and underwent synchronous ( n = 4) or sequential ( n = 5) VATS resections. Preoperative CT-guided hook wire localization of the lesions was performed in 65 patients (84 %). The postoperative mortality and morbidity rates were 0 and 5.2 %, respectively. During a mean follow-up time of 24 months (range 1-120 months), tumor progression occurred in 46 patients. Twenty-three patients (30 %) had pulmonary recurrence only, of them, eight patients (10 %) in the operated lungs. Seven of eight patients with recurrence in the operated lungs underwent a second metastasectomy by VATS ( n = 5) or thoracotomy ( n = 2). The overall 5-year survival rate was 54 % and without difference between patients without tumor recurrence and those with pulmonary recurrence treated by re-metastasectomy. Conclusion: Ipsilateral recurrence remains low after VATS pulmonary metastasectomy guided by preoperative HRCT and can be efficiently treated by re-metastasectomy. [ABSTRACT FROM AUTHOR]