Table 1 Major series reporting surgical management of pulmonary metastases from gynaecological malignancies

Adachi [29] 2015

23

Epithelial gynecologic cancers Major series reporting suCervical – 60.9 %

Endometrial – 17.4 %

Ovarian – 21.7 %

1 nodule – 69.6 %

2–3 nodules – 30.4 %

VATS – 56.5 %

Conventional thoracotomy – 43.5 %

5 year OS:

Cervical – 61 %

Endometrial – 100 %

Ovarian – 100 %

Recurrence – 43.4 %

Univariate analysis – positive prognostic factors for survival:

Endometrioid vs mucinous adenoca

DFI >2 years

Gonzalez Casaurran [19] 2011

27

Uterine and cervical cancer

1 metastasis – 66.7 %

2 metastases – 18.5 %

≥2 metastases – 14.8 %

Surgical approach:

- thoracotomy – 81.5 %

- sequential bilateral – 7.4 %

- unilateral VATS – 3.7 %

- sequential bilateral VATS – 3.7 %

- VATS + thoracotomy – 3.7 %

Lung resection:

- Wedge resection – 81.5 %

- Lobectomy – 11.1 %

- Other – 7.4 %

Second surgery for metastases - 18.5 %

Median survival from diagnosis of metastases – 94 months

5-year OS after diagnosis of metastases – 84.1 %

Overall relapse rate 44 %

Positive prognostic factors

Primary site – endometrial vs cervical (P = 0.023)

DFI >24 months (p = 0.054)

Burt [22] 2011

82

Sarcoma

Included male and female patients

Leiomyosarcoma – 31 cases (38 %) - 24 pts (77 %) of these were female

In female pts, uterus most common primary site

Solitary metastases – 16 pts (52 %)

Bilateral disease – 19 %

- Wedge resection – 71 %

- Lobectomy – 23 %

- Segmentectomy – 6 %

- VATS – 58 %

5 year survival:

- Leiomyosarcoma – 52 %

- other sarcoma – 32 %

2^nd pulmonary metastasectomy – 58.5 %

Second pulmonary recurrence - 30.5 %

Multivariate analysis – DFI >12 months from time of primary tumour resection

Lim [90] 2010

21

Primary and recurrent cervical cancer

Not reported

23 resections in 21 patients

- thorocatomies – 43.5 %

- VATS – 52.2 %

- VATS following thoracotomies – 4.3 %

Procedures – 49

- wedge resections – 51.1 %

- lobectomies – 18.4 %

- mediastinal LN dissections – 24.5 %

- segmentectomy – 2.0 %

- diaphragmatic resection −2.0 %

- pleurectomy – 2.0 %

Note – only 14 patients had recurrent cervical cancer, and 1 patient had primary lung cancer and mediastinal LN metastasis from cervical cancer

Median f/up 16 months (range 2–67)

- 2 pts died of disease

- 3 pts alive with disease

- 16 pts alive without disease

Not reported

Clavero [23] 2006

70

Uterine corpus – 52.9 %

Endometrium – 32.9 %

Cervix – 10.0 %

Ovaries – 2.9 %

Vagina – 1.3 %

Histopathology:

Leiomyosarcoma – 41.4 %

Adenocarcinoma – 32.9 %

Other sarcoma – 15.7 %

SCC −7.1 %

Other – 2.9 %

Median number of lung metastases – 2 (range 1–19)

Wedge excision – 63 %

Lobectomy – 20 %

Bilobectomy – 3 %

Pneumonectomy – 2.5 %

Combination – 12.5 %

5-year OS 46.8 % (95 % CI 34.2-63.0 %)

10 year OS – 34.3 % (95 % CI 19.7-52.5 %)

Factors that adversely affected survival:

DFI between 1^st gynecologic procedure and pulmonary resection <24 months (p = 0.004)

Primary site in cervix (p < 0.001)

Yamomoto [28] 2004

29 (out of 7748 = 0.37 %)

Cervical cancer (Stage Ib or II treated with curative intent surgery or radiotherapy)

Solitary metastasis – 58.6 %

Multiple metastases – 43.4 %

Wedge resection – 27.6 %

Segmentectomy – 6.9 %

Lobectomy – 65.5 %

Hilar or mediastinal lymph node dissection – 55.2 %

5 year DFS after pulmonary metastasectomy – 32.9 %

For DFS:

- ≤2 metastases

- SCC

Anraku [21] 2004

133

Uterine malignancies (cervix and endometrium) Histopathology:

SCC – 43.6 %

Cervical adenocarcinoma – 9.8 %

Endometrial adenocarcinoma – 17.3 %

Choriocarcinoma – 12.0 %

Leiomyosarcoma – 4.7 %

Solitary metastasis −58 %

2–3 mets – 23 %

≥4 mets – 17

%

Wedge resection – 50 %

Lobectomy – 45 %

Bilobectomy – 2.5 %

Pneumonectomy – 2.5 %

Overall survival after surgical resection:

5-year – 54.6 %

10-year – 44.9 %

5-year survival by histpathological type:

SCC – 46.8 %

Cervical adenoca – 40.3 %

Endometrial adenoca – 75.7 %

Choriocarcinoma – 86.5 %

Leiomyosarcoma – 37.9 %

Univariate analysis – negative prognostic factors:

Primary tumour in cervix

DFI <12 months

Resection ≥ 4 mets

Large tumour size (≥3 cm)

Multivariate analysis:

DFI < 12 months

Anderson [20] 2001

82 eligible pts

25 underwent pulmonary resection

Eligible patients:

Uterine – 73.2 %

Cervical – 26.8 %

Patients undergoing resection:

Uterine – 76.0 %

Cervical – 24.0 %

Solitary – 28 %

Multiple – 72 %

Uterine:

- Wedge – 63.1 %

- Lobectomy – 10.5 %

- Lobectomy/wedge – 15.8 %

- Bilobectomy – 5.3 %

- Segmentectomy – 5.3 %

Cervix:

- Wedge – 66.7 %

- Lobectomy – 33.3 %

Uterine cancer

- median survival 26 months

- Leiomyosarcoma −25 months

- Adenocarcinoma – 46 months

Cervix cancer

- median survival 36 months

Uterine cancer – favourable prognostic factors:

Leiomyosarcoma vs adenocarcinoma (p = 0.02)

Levenback [27] 1992

45

Uterine sarcomas:

- Leiomyosarcoma – 84 %

- Endometrial stromal sarcoma – 9 %

- Mesodermal mixed tumours – 7 %

Unilateral lesions – 71 %

1 lesion – 51 %

Nodules >2 cm – 70 %

Staged thoracotomies – 100 %

Median sternotomy and bilateral resections – 4.4 %

Incomplete resection – 36 %

From time of pulmonary resection:

- 5 year survival – 43 %

- 10 year survival – 35 %

Median follow-up – 89 months

Disease recurrence – 42 %

Significant predictors:

- unilateral vs bilateral disease

Not significant:

- metastasis size

- number of metastases

- disease free interval

- patient age