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. 2019 Sep;120(4):768-778.
doi: 10.1002/jso.25635. Epub 2019 Jul 11.

Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence

Francesco Londero  1 , Angelo Morelli  1 , Orlando Parise  2 , William Grossi  1 , Sara Crestale  1 , Cecilia Tetta  3 , Daniel M Johnson  2 , Ugolino Livi  1 , Jos G Maessen  2 , Sandro Gelsomino  2
Affiliations

Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence

Francesco Londero et al. J Surg Oncol. 2019 Sep.

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.

Keywords: lung metastases; lung resections; lymphadenectomy.

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Conflict of interest statement

The authors declare that there is no conflict of interests.

Figures

Figure 1
Figure 1
A, Actuarial survival in the whole population. B, Overall survival by groups (Lymphadenectomy, L+ and no‐ lymphadenectomy, L−)
Figure 2
Figure 2
A, Cumulative incidence of recurrence in the whole population. B, Cumulative incidence of recurrence by groups (lymphadenectomy, L+ and no‐ lymphadenectomy, L−)
Figure 3
Figure 3
A, Predictors of death at Cox Regression. B, Predictors of recurrence at competing‐risk analysis. CI, confidence interval; HR, hazard risk; SHR, sub‐hazard risk. DFI, disease‐free interval
Figure 4
Figure 4
Sub‐analysis for death. A, Interaction between lung comorbidities and potential influencing factors. B, Interaction between disease‐free survival (DFS) and potential influencing factors. CI, confidence interval; HR, hazard risk; NSCLC, non‐small–cell lung cancer
Figure 5
Figure 5
Sub‐analysis for recurrence. A, Interaction between multiple metastases and potential influencing factors. B, Interaction between head/neck tumor and potential influencing factors. C, Interaction between age and potential influencing factors. CI, confidence interval; SHR, sub‐hazard risk
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