Pulmonary Metastasectomy: Common Practice But Is It Best
In an attempt to search for the evidence available in the literature to support an aggressive locoregional treatment for patients with pulmonary metastases, in 2005 the council of ESTS approved the formation of a novel working group, who's aim was to establish pulmonary metastasectomy guidelines for its members. An extensive literature search was conducted, looking for all references related to pulmonary metastasectomy available at that time. A list of debated questions relevant to the practice of pulmonary metastasectomy was composed and distributed along with the reference list to members of seven subgroups. each dealing with one specific topic. A workshop on pulmonary metastasectomy attended by 20 participating members was organized in Cluj-Napoca, Romania, 10–11 May 2006 preceding the 3rd spring meeting of ESTS. Chairs of the subgroups were asked to present the level of evidence available in current literature on the different questions.
First, a web-based questionnaire was created by Dr. Eveline Internullo from the University of Parma, Italy in order to survey the current approach on lung metastasectomy amongst the members of ESTS. One hundred forty-six complete responses were received from 494 consultant members working in 29 different countries. Questions were posed regarding preoperative work up, histology of primary tumor, indications and perceived contraindications, surgical approach, extent of resection, surgical technique, practice of mediastinal nodal assessment and dissection and postoperative follow up. Results of the survey were published in 2008 in the Journal of Thoracic Oncology accompanied by an editorial written by Dr Harvey Pass from NYU Langone Medical Center, NY, USA entitled 'The Mets, The Scalpels, and possibly the Beams'. This survey revealed areas of consistency in current clinical practice: pulmonary metastasectomy is not warranted in cases where complete resection of lung metastases is unlikely or where the primary tumor is uncontrolled. The survey also confirmed areas where considerable debate remains, as evidenced by the wide variability of practice regarding the role of repeat metastasectomy and the surgical approach. While this survey simply provides a time-sensitive perspective of the patterns of practice in pulmonary metastasectomy, it was the largest such comprehensive examination of clinical practice in this field of surgery at the time.
Second, Professors Tom Treasure (University College London, UK) and Frank Detterbeck (Yale University, CT, USA) were appointed as editorial chairs to produce a series of papers on the topic of pulmonary metastasectomy including the reports of the different working groups. A 64-page supplement as a final report of the working group was published in 2010 in the Journal of Thoracic Oncology accompanied by an editorial written by Dr Valerie Rush from Memorial Sloan–Kettering Cancer Center, NY, USA entitled 'Pulmonary metastasectomy: a moving target'.
The ESTS Lung Metastasectomy Working Group
In an attempt to search for the evidence available in the literature to support an aggressive locoregional treatment for patients with pulmonary metastases, in 2005 the council of ESTS approved the formation of a novel working group, who's aim was to establish pulmonary metastasectomy guidelines for its members. An extensive literature search was conducted, looking for all references related to pulmonary metastasectomy available at that time. A list of debated questions relevant to the practice of pulmonary metastasectomy was composed and distributed along with the reference list to members of seven subgroups. each dealing with one specific topic. A workshop on pulmonary metastasectomy attended by 20 participating members was organized in Cluj-Napoca, Romania, 10–11 May 2006 preceding the 3rd spring meeting of ESTS. Chairs of the subgroups were asked to present the level of evidence available in current literature on the different questions.
First, a web-based questionnaire was created by Dr. Eveline Internullo from the University of Parma, Italy in order to survey the current approach on lung metastasectomy amongst the members of ESTS. One hundred forty-six complete responses were received from 494 consultant members working in 29 different countries. Questions were posed regarding preoperative work up, histology of primary tumor, indications and perceived contraindications, surgical approach, extent of resection, surgical technique, practice of mediastinal nodal assessment and dissection and postoperative follow up. Results of the survey were published in 2008 in the Journal of Thoracic Oncology accompanied by an editorial written by Dr Harvey Pass from NYU Langone Medical Center, NY, USA entitled 'The Mets, The Scalpels, and possibly the Beams'. This survey revealed areas of consistency in current clinical practice: pulmonary metastasectomy is not warranted in cases where complete resection of lung metastases is unlikely or where the primary tumor is uncontrolled. The survey also confirmed areas where considerable debate remains, as evidenced by the wide variability of practice regarding the role of repeat metastasectomy and the surgical approach. While this survey simply provides a time-sensitive perspective of the patterns of practice in pulmonary metastasectomy, it was the largest such comprehensive examination of clinical practice in this field of surgery at the time.
Second, Professors Tom Treasure (University College London, UK) and Frank Detterbeck (Yale University, CT, USA) were appointed as editorial chairs to produce a series of papers on the topic of pulmonary metastasectomy including the reports of the different working groups. A 64-page supplement as a final report of the working group was published in 2010 in the Journal of Thoracic Oncology accompanied by an editorial written by Dr Valerie Rush from Memorial Sloan–Kettering Cancer Center, NY, USA entitled 'Pulmonary metastasectomy: a moving target'.