Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence |
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Authors: | Francesco Londero MD Angelo Morelli MD Orlando Parise MSc William Grossi MD Sara Crestale MD Cecilia Tetta MD Daniel M Johnson PhD Ugolino Livi MD Jos G Maessen MD PhD Sandro Gelsomino MD PhD FESC |
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Institution: | 1. Department of Cardiothoracic Surgery, Santa Maria della Misericordia University Hospital, Udine, Italy;2. Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands;3. Radiology Department, Rizzoli Institute, Bologna, Italy |
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Abstract: | Background and Objectives: Lymphadenectomy during pulmonary metastasectomy (PM) is widely carried out. We assessed the potential benefit on patient survival and tumor recurrence of this practice. Methods: One hundred eighty-one patients undergoing a first PM were studied. Eighty-six patients (47.5%) underwent lymphadenectomy (L+ group) whereas 95 (52.5%) did not undergo nodal harvesting (L?group). Main outcomes were overall survival (OS) and disease-free survival (DFS). Median follow-up was 25 months (interquartile range IQR], 13-49). Results: At follow-up 84 patients (46.4%) died, whereas 97 (53.6%) were still alive with recurrence in 78 patients (43%). There was no difference in 5-year survival (L+ 30.0% vs L? 43.2%; P = .87) or in the 5-year cumulative incidence of recurrence (L + 63.2% vs L?80%; P = .07) between the two groups. Multivariable analysis indicated that disease-free interval (DFI) less than 29 months (P < .001) and lung comorbidities (P = .003) were significant predictors of death. Metastases from non-small–cell lung cancer increased the risk of lung comorbidities by a factor of 19.8, whereas the risk of DFI less than 29 months was increased nearly 11-fold. Competing risk regression identified multiple metastases (P = .004), head/neck primary tumor (P = .009), and age less than 67 years (P = .024) as independent risk factors for recurrence. Conclusion: Associated lymphadenectomy showed not to give any additional advantage in terms of survival and recurrence after PM. |
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Keywords: | lung metastases lung resections lymphadenectomy |
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