Survival after video-assisted thoracoscopic surgery for lung metastasectomy

Background: In selected patients with pulmonary metastases, surgical resection is the treatment of choice. Despite thoracoscopy is the preferred approach for management early lung cancer, its role in management pulmonary metastases is still debate due to the risk of leaving undetected malignant nodules during surgery. We aimed to evaluate the outcome of patients undergoing resection of lung metastasis performed using thoracoscopy to establish whether this approach did not compromise oncological results.Methods: We performed a systematic review of literature using Medline, PubMed, Scopus, Google Scholar, and Cochrane databases until the end of March 2020. English papers reporting the survival and/or recurrence after thoracoscopic metastasectomy were included in the analysis.Results: Ten papers were selected. Nine out of ten studies compared survival and/or recurrence rates between thoracoscopy and thoracotomy approach; no significant differences were found in 7 studies, while in two thoracoscopy was associated with a better overall survival. The remaining one study evaluated only thoracoscopy outcome, finding an overall 5-year survival rate of 54%, that was comparable to that expected for metastasectomy by thoracotomy. Multivariable analysis were performed in four studies; in one thoracoscopy was correlated to better survival, while in the other three the surgical approach did not influence outcomes. Two studies evaluated perioperative outcomes, and in both studies thoracoscopy was associated with shorter hospital stay, and lesser postoperative morbidity than thoracotomy.Conclusions: Despite our results seems to support the use of thoracoscopy, however several limitations should be taken in account before drawing definitive conclusions. All evaluated studies are retrospective; the different patient characteristics (i.e. number of lesions, laterality, size, primary metastatic cancer type), and the extend of resection make thoracoscopy and thoracotomy groups not comparable. Thus, only future randomized controlled trials could definitively define the oncological validity of video-assisted thoracoscopic surgery (VATS) for treatment of lung metastases