The aim of this study was to investigate if laser-assisted resection is appropriate for large and/or central lung metastases, when stapler wedge resection is not feasible, to determine whether this technique can be an alternative to lobectomy. All patients who underwent laser-assisted resection for large and/or central metastases were selected for the study. For comparison, patients who underwent lobectomy for metastases between 2005 and 2017 were reviewed. All resections were performed with a 1318-nm Nd:YAG laser. Perioperative features and long-term oncological outcomes were investigated. Some aspects and drawbacks of laser resection were also investigated. Among 89 patients, 42 (47%) underwent laser resection and 47 underwent lobectomy. Complete resection was achieved in 91% of laser resections and in 98% of lobectomies. The operative time, postoperative drainage time, and length of stay were significantly shorter in patients who underwent laser resection than in those who underwent lobectomy. Severe postoperative complications tended to be more frequent after lobectomy. The 5-year survival was 66% and 54% after laser resection and lobectomy respectively; the 5-year disease-free survival was 35% and 32% after laser resection and lobectomy respectively. No differences were found in long-term outcomes between the two techniques. Our experience showed that laser resection, when performed for large/central metastases, resulted in comparable survival and obtained better perioperative outcomes with respect to lobectomy. We believe that laser resection can be proposed as a reliable and advantageous lung-sparing technique, as an alternative to lobectomy for metastasectomy, when stapler wedge resection is not feasible.
Lung Metastases Laser Lobectomy
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Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All the procedures performed in this study were in accordance with the ethical standards of the Institutional Ethical Committee (Ethical Committee of the Area Vasta Emilia Nord—No.: CE547/2018).
Informed consent was waived because of the observational retrospective nature of the study.
Treasure T, Milosevic M, Fiorentino F, Macbeth F (2014) Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness? Thorax 69:946–949CrossRefGoogle Scholar
Patrini D, Panagiotopoulos N, Lawrence D, Scarci M (2017) Surgical management of lung metastases. Br J Hosp Med 78:192–198CrossRefGoogle Scholar
Pastorino U, Buyse M, Friedel G, Ginsberg RJ, Girard P, Goldstraw P et al (1997) Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 113:37–49CrossRefGoogle Scholar
Lang C, Hoetzenecker K, Schweiger TS (2019) Emerging biomarkers in pulmonary metastasectomy. J Vis Surg 5:44CrossRefGoogle Scholar
Mineo TC, Ambrogi V, Pompeo E, Nofroni I (1998) The value of the Nd:YAG laser for the surgery of lung metastases in a randomized trial. Chest 113:1402–1407CrossRefGoogle Scholar
Moghissi K, Dench M, Neville E (1989) Effect of the non-contact mode of YAG laser on pulmonary tissues and its comparison with electrodiathermy: an anatomic-pathological study. Lasers Med Sci 4:17–23CrossRefGoogle Scholar
Rolle A, Pereszlenyi A, Koch R, Richard M, Baier B (2006) Is surgery for multiple lung metastases reasonable? A total of 328 consecutive patients with multiple-laser metastasectomies with a new 1318-nm Nd:YAG laser. J Thorac Cardiovasc Surg 131:1236–1242CrossRefGoogle Scholar
Franzke K, Natanov R, Zinne N, Rajab TK, Biancosino C, Zander I et al (2017) Pulmonary metastasectomy: a retrospective comparison of surgical outcomes after laser-assisted and conventional resection. Eur J Surg Oncol 43:1357–1364CrossRefGoogle Scholar
Welter S, Arfanis E, Christoph D, Hager T, Roesel C, Aigner C et al (2017) Growth patterns of pulmonary metastases: should we adjust resection techniques to primary histology and size? Eur J Cardiothorac Surg 52:39–46CrossRefGoogle Scholar
Porrello C, Gullo R, Vaglica A, Scerrino G, Salamone G, Licari L et al (2018) Pulmonary laser metastasectomy by 1318-nm neodymium-doped yttrium-aluminium garnet laser: a retrospective study about laser metastasectomy of the lung. Surg Innov 25:142–148CrossRefGoogle Scholar
Ojanguren A, Karenowics W, Dackam S, Demarchi M, Triponez F (2019) Laser pulmonary metastasectomy by video-assisted thoracic surgery. J Vis Surg 5:40 (April 12th 2019)CrossRefGoogle Scholar
Mineo TC, Ambrogi V, Tonini G, Nofroni I (2001) Pulmonary metastasectomy: might the type of resection affect survival? J Surg Oncol 76:47–52CrossRefGoogle Scholar
Caristo JM, Tian DH, Yan TD (2018) Pulmonary metastasectomy: a cross sectional survey. J Thorac Dis 10:3757–3766CrossRefGoogle Scholar
Baier B, Kern A, Kederali L, Bis B, Koschel D, Rolle A (2015) Retrospective survival analysis of 237 consecutive patients with multiple pulmonary metastases from advanced renal cell carcinoma exclusively resected by a 1318-nm laser. Interact Cardiovasc Thorac Surg 21:211–217CrossRefGoogle Scholar
Schmid S, Le UT, Zeisal C, Haager B, Passlick B (2018) Pulmonary metastasectomy in sarcoma - experiences with laser-assisted resection. J Thorac Dis 10:314–320CrossRefGoogle Scholar
Rolle A, Unsold E, Ruprecht L, Permanetter W, Frank F et al (1988) Morphologic aspects of Nd:YAG laser application: wavelength 1064 nm and 1318 nm on lung tissue. Laser Med Surg 4:10–14Google Scholar
Osei-Agyemang T, Palade E, Haderthauer J, Ploenes T, Yaneva V, Passlick B (2013) Pulmonary metastasectomy: an analysis of technical and oncological outcomes in 301 patients with a focus on laser-resection. Zentralbl Chir 138:S45–S51CrossRefGoogle Scholar
McLaughlin JB, O’Sullivan KE, Brown RH, Eaton D (2018) Limax Nd:YAG laser-assisted thoracoscopic resection of pulmonary metastases; a single centre’s initial experience. Ir J Med Sci 188(3):771–776Google Scholar
Kirschbaum A, Steinfeldt T, Gockel A, DiFazio P, Quint K, Bartsch DK (2014) Airtighness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG laser LIMAX 120. Interact Cardiovasc Thorac Surg 18:92–95CrossRefGoogle Scholar
Meyer C, Bartsch D, Mirow N, Kirschbaum A (2017) Video-assisted laser resection of lung metastases - feasibility of a new surgical technique. Thorac Cardiovasc Surg 65:382–386CrossRefGoogle Scholar
Marulli G, Droghetti A, DiChiara F, Calabrese F, Rebusso A, Perissinotto E et al (2013) A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy. Lasers Med Sci 28:505–511CrossRefGoogle Scholar