- 标题
- 摘要
- 关键词
- 实验方案
- 产品
-
Laser pulmonary metastasectomy by video-assisted thoracic surgery
摘要： Indications and surgical approach for pulmonary metastasectomy remain controversial as randomized clinical trials are lacking to validate its effectiveness. To this end, non-anatomical lung wedge resection, widely performed by staplers, persists as preferred surgical procedure. With the advent of new technologies, laser assisted surgery evolved and has been advocated mainly for multiple pulmonary metastases in open surgery fashion. However, video-assisted thoracic surgery (VATS) laser pulmonary metastasectomy has been rarely reported. This review is based on a selective search of the PubMed database for articles that were published from 1990 to 2018 and contained the keywords ‘laser assisted surgery’, ‘pulmonary metastasectomy’, ‘thoracoscopic laser metastasectomy’, and ‘VATS’. No prospective clinical trial has been performed to provide evidence whether to treat pulmonary metastasis with laser or conventional techniques. According to retrospective cohort studies and descriptive series, open approach laser assisted surgery facilitates the resection of a higher number of metastases, sparing healthy lung parenchyma, while obtaining similar recurrence rates compared to conventional staplers. In central lesions, optimal surgical margins can be achieved around the lesion avoiding injury to deep located structures such as major vessels or bronchus. However, evidence about thoracoscopic laser pulmonary metastasectomy is remarkably poor consisting in only a few small series of patients with one or two resected metastases. Laser assisted pulmonary metastasectomy is safe and effective. Video-assisted laser resection of lung metastases is a marginal technique to date. Postulated benefits of open laser assisted pulmonary metastasectomy could not be assumed by thoracoscopic approach with available data. Further studies are needed to demonstrate whether multiple and centrally lesions could be effectively resected by thoracoscopic laser metastasectomy.
关键词： thoracoscopic laser metastasectomy,Laser assisted surgery,video-assisted thoracic surgery (VATS),pulmonary metastasectomy
更新于2025-09-23 15:19:57
-
Pulmonary laser-assisted metastasectomy is associated with prolonged survival in patients with colorectal cancer
摘要： Background: Pulmonary metastases develop in 10–15% of patients with colorectal cancer. Surgical metastasectomy currently provides the only hope for a cure for these patients. The aim of this study was to analyze the expanding role of pulmonary metastasectomy in the context of laser-assisted surgery (LAS) vs. non-laser-assisted surgery (NLAS). Methods: We performed a single-center retrospective analysis of 204 patients who underwent curative pulmonary metastasectomy for colorectal cancer between 01/2005 and 12/2016. The main endpoint was survival. The Kaplan-Meier method was applied for statistical analysis and survival rates were compared with the log rank test. Results: Median follow-up was 53 months. A total of 267 metastases were resected in 154 operations in the NLAS group (median: 1) vs. 438 metastases in 122 operations in the LAS group (median: 5; P<0.0001). The interval between treatment of the primary tumor and the first pulmonary metastasectomy was significantly shorter in the LAS group (19 vs. 32 months; P=0.008). Anatomical resections were significantly reduced using LAS, 8% vs. 23% respectively. Despite more negative predictors in the LAS group, there was no statistically significant difference in overall disease-specific 5-year survival (70% LAS vs. 58% NLAS; P=0.18). Conclusions: Survival after pulmonary metastasectomy has previously been shown to correlate with a low number of metastases and a longer disease-free interval. However, with the tissue-saving LAS technique complete resectability can be achieved in patients with more metastases and long-term survival is possible for selected patients.
关键词： Pulmonary metastasectomy,laser-assisted surgery (LAS),colorectal cancer,survival
更新于2025-09-11 14:15:04