Comparison of Median Sternotomy and Thoracotomy for Resection of Pulmonary Metastases in Patients with Adult Soft-Tissue Sarcomas

doi:10.1016/S0003-4975(10)60504-8

The Annals of Thoracic Surgery

Volume 42, Issue 2, August 1986, Pages 134-138

https://doi.org/10.1016/S0003-4975(10)60504-8 Get rights and content

Abstract

Thoracotomy and median sternotomy have both been advocated for resection of pulmonary metastases, and the advantages of each approach remain disputed. Patients with adult soft-tissue sarcomas undergoing resection of pulmonary metastases at the National Cancer Institute were studied retrospectively to assess the results of each surgical approach. Between 1981 and 1984, 65 patients underwent 78 sternotomies (7 lobectomies, 71 wedge resections); a mean of 9.5 nodules were resected per patient (range, 1 to 61).

Resection of all nodules was accomplished in 60 of 71 explorations (84%) in patients with documented metastases. Benign lesions were found during 7 explorations (9%). Thirteen of 30 patients (43%) with unilateral metastases on linear tomography (LT), 45% (9 of 20) of patients with unilateral metastases on computed tomography (CT), and 38% (5 of 13) of patients with unilateral metastases on both CT and LT had bilateral metastases at sternotomy. Survival by type of incision was compared for 84 patients who underwent complete resection of their metastases (42 by sternotomy and 42 by thoracotomy); the minimum follow-up was two years. The groups did not differ significantly with respect to prognostic variables (tumor doubling time, disease-free interval, or number of nodules resected). There was no significant difference in actuarial survival between the two groups. The complication rate was 15% for the sternotomy group and 10% for the thoracotomy group (difference not significant). There were no operative deaths. Median sternotomy results in detection of unsuspected bilateral metastases and avoidance of a second operative procedure, but it does not increase operative morbidity or mortality or compromise overall patient survival.

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Citation Excerpt :
The need for bilateral exploration of the lungs even in patients with unilateral disease was based on the assumption that a systemic disease has a great probability of bilateral involvement that could comprise the survival of the patient. At least two studies have found no advantage on bilateral exploration in patients with unilateral metastases and the actual recommendation is delaying a contralateral thoracotomy until disease evident on radiological studies [18,19] On the other hand, options for resection of bilateral metastases comprise a single (bilateral approach, either a Clamshell incision or a median sternotomy) versus a staged procedure (single-side anterolateral or posterolateral thoracotomy). Sternotomy and Clamshell incisions have the advantage of treating both lungs in a single surgical event, but exposure of lower lobes and posterior surface of the lungs can be difficult; again, there is not any reported advantage in survival with this approach [20].
Lung metastasectomy is an area of interest and controversy in surgical oncology. Most of the available evidence derives from small cohorts with short follow-up. The aim of this study was to evaluate the oncologic outcomes in an 18-year cohort from a single center. We retrospectively reviewed 398 patients with several malignancies who underwent lung metastasectomy between January 1990 and December 2008. Demographic, clinical, and surgical variables were evaluated. Uni- and multivariate analyses were performed to identify factors associated with overall survival (OS). Mean follow-up was 20 months. Wedge resection was performed in 297 cases and 101 required anatomic resections. In 303 patients the disease-free interval (DFI) was >6 months meanwhile 95 patients had a DFI ≤6 months. Complete resection was achieved in 351 patients (88.2%). Median OS for all patients was 81.9 months (95% CI, 36.9–126.9). On multivariate analysis, factors associated with a poor overall survival were DFI <6 months (HR, 1.74; 95% CI, 1.24–2.4; p = 0.001) and incomplete resection (HR, 1.58 95% CI, 1.01–2.5; p = 0.0047). Independent prognostic factors associated with better survival were DFI >6 months and complete resection. Size and number of metastases as well as re-do metastasectomy were not associated with worse survival.

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: Presented at the Thirty-second Annual Meeting of the Southern Thoracic Surgical Association, Boca Raton, FL, Nov 7–9, 1985.

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Comparison of Median Sternotomy and Thoracotomy for Resection of Pulmonary Metastases in Patients with Adult Soft-Tissue Sarcomas

Abstract

Cancer Treat Rep

Am J Surg

Orthop Clin N Am

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Dis Chest

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg