Thoracoscopic Resection of a Solitary Pulmonary Nodule in Patients with a Known History of Malignancy

Abstract

Background: Solitary pulmonary nodules found during the follow-up of cancer patients are generally considered to be lung metastases. However, a definite diagnosis should be established. Methods: Between 1995 and 2005, all patients with a solitary lung nodule considered removable by a thoracoscopic approach and with a history of malignancy were included in this study. Lung wedge resection was performed to establish the morphological diagnosis. During follow-up further metastases and local recurrences were registered. Survival data were obtained in February 2007. Results: Among our 34 patients (17 male and 17 female with a median age of 67.5 years), the most common primary cancers were colorectal (n = 12) and kidney (n = 6). Two patients had a history of 2 cancers. Twenty-two patients (65 %) had lung metastases and 12 (35 %) had benign nodules. During follow-up (median 2.4 years) 7 patients (21 %) developed further lung metastases. Overall postoperative five-year survival was 50 % (95 % CI: 35 – 73 %). Conclusion: Not all solitary lung nodules in patients with previous malignancy are metastases. According to our survival results the thoracoscopic removal of a single lung metastasis was curative in many patients.

Key words

lung metastasis - solitary pulmonary nodule - VATS

References

• 1 Toomes H, Delphendahl A, Manke H G, Vogt-Moykopf I. The coin lesion of the lung. A review of 955 resected coin lesions.  Cancer. 1983;  51 534-537
• 2 Jimenez M F. The Spanish Video-Assisted Thoracic Surgery Study Group. Prospective study on video-assisted thoracoscopic surgery in the resection of pulmonary nodules: 209 cases from the Spanish Video-Assisted Thoracic Surgery Study Group.  Eur J Cardiothorac Surg. 2001;  19 562-565
• 3 Cardillo G, Regal M, Sera F. et al . Videothoracoscopic management of the solitary pulmonary nodule: a single-institution study on 429 cases.  Ann Thorac Surg. 2003;  75 1607-1612
• 4 Khokhar S, Vickers A, Moore M S, Mironov S, Stover D E, Feinstein M B. Significance of non-calcified pulmonary nodules in patients with extrapulmonary cancers.  Thorax. 2006;  61 331-336
• 5 Mary C M, Pappas A N, Bueno R. et al . Relationship between a history of antecedent cancer and the probability of malignancy for a solitary pulmonary nodule.  Chest. 2004;  125 2175-2181
• 6 Chang E Y, Johnson W, Karamlou K. et al . The evaluation and treatment implications of isolated pulmonary nodules in patients with a recent history of breast cancer.  Am J Surg. 2006;  191 641-645
• 7 Dowling R D, Keenan R J, Ferson P F, Landreneau R J. Video assisted thoracoscopic surgery of pulmonary metastases.  Ann Thorac Surg. 1993;  56 772-775
• 8 Rena O, Papalia E, Oliaro A. et al . Pulmonary metastases from epithelial tumours: late results of surgical treatment.  Eur J Cardiothorac Surg. 2006;  30 217-222
• 9 Saito Y, Omiya H, Kohno K. et al . Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment.  J Thorac Cardiovasc Surg. 2002;  124 1007-1013
• 10 Pastorino U, Buyse M, Friedel G. et al . Long-term results of lung metastasectomy: prognostic analysis based on 5206 cases.  J Thorac Cardiovasc Surg. 1997;  113 37-49
• 11 Kayton M L, Huvos A G, Casher J. et al . Computed tomographic scan of the chest underestimates the number of metastatic lesions in osteosarcoma.  J Ped Surg. 2006;  41 200-206
• 12 Parsons A M, Detterbeck F C, Parker L A. Accuracy of helical CT in the detection of pulmonary metastases: is intraoperative palpation still necessary?.  Ann Thorac Surg. 2004;  78 1910-1918
• 13 Roth J A, Pass H I, Wesley M N, White D, Putnam J B, Seipp C. Comparison of median sternotomy and thoracotomy for resection of pulmonary metastases in patients with adult soft tissue sarcomas.  Ann Thorac Surg. 1986;  42 134-138
• 14 Martini N, McCormack P M, Bains M S. Surgery for solitary and multiple pulmonary metastases.  NY State J Med. 1978;  78 1711-1713
• 15 Mutsaerts E L, Zoetmulder F A, Meijer S, Baas P, Hart A A, Rutgers E J. Outcome of thoracoscopic pulmonary metastasectomy evaluated by confirmatory thoracotomy.  Ann Thorac Surg. 2001;  72 230-233
• 16 Swoboda L, Toomes H. Results of surgical treatment of pulmonary metastases.  Thorac Cardiovasc Surgeon. 1986;  34 149-152
• 17 Okumura S, Kondo H, Tsuboi M. et al . Pulmonary resection for metastatic colorectal cancer: experiences with 159 patients.  J Thorac Cardiovasc Surg. 1996;  112 867-874
• 18 Landreneau R J, De Giacomo T, Mack M J. et al . Therapeutic video-assisted thoracoscopic surgical resection of colorectal pulmonary metastases.  Eur J Cardiothorac Surg. 2000;  18 671-677
• 19 De Giacomo T, Redina E A, Venuta F, Ciccone A M, Coloni G F. Thoracoscopic resection of solitary lung metastases from colorectal cancer is a viable therapeutic option.  Chest. 1999;  115 1441-1443